Ziehm Vision. Ziehm Vision FD. User Manual. Table of Contents. About this Manual 1. System Overview 2. Safety Instructions 3

Transcription

1 FD User Manual Table of Contents About this Manual 1 System Overview 2 Safety Instructions 3 Putting the System into Service 4 Mechanical Handling 5 Controls 6 Switching the System On 7 Standard Fluoroscopic Operations 8 Adjusting Live Images 9 Data Management 10 DICOM Functions 11 Cine Loops 12 Subtraction Modes 13 Post-Processing Images 14 Measurements 15 Displayed Texts and Text Functions 16 Image Documentation 17 Laser Positioning Device 18 Direct Radiography 19 System Configuration 20 C-Arm Power Assist (U.S. Option) 21 Appendix Index

2 Safety instructions Intended use Operation (U.S.A.) Authorized personnel Exclusion of liability This manual does not constitute a complete catalog of all safety measures necessary for the operation of the respective medical equipment, since special operating conditions may require further measures. However, it does contain instructions which must be observed in order to ensure the personal safety of operating staff and patients as well as to avoid damage to property. The medical equipment is intended for fluoroscopies in the field of surgery, e.g. in traumatology, orthopedics, neurology, urology, cardiology. Third-party devices and components used in combination with this system must comply with the safety requirements according to IEC and/or IEC or furnish proof of an equivalent degree of safety. To ensure CE conformity, these components must have a CE approval in accordance with Council Directive 93/42/EEC. In addition, a declaration in compliance with Article 12 of the said directive must be provided. For components without CE approval, a conformity assessment procedure is obligatory. Proper and safe operation of the system requires adequate transportation, storage, assembly and installation as well as appropriate use and maintenance. The limiting values indicated in this user manual must not be exceeded; this applies also when putting the system into service. In the U.S.A., Federal law restricts use of this device to trained personnel on the order of a physician. Only authorized personnel are allowed to assemble and/or repair the medical equipment described in this manual. Authorized personnel are persons who have attended an appropriate training course provided by the manufacturer. The manufacturer accepts responsibility for the safety, reliability and performance of the system only if any installation, modification or repair work is carried out exclusively by persons authorized by the manufacturer; the electrical installation of the site where the system is operated complies with the requirements of VDE 0107 or the corresponding national regulations of the country of installation; the system is used in accordance with the user manual. The warranty becomes invalid in case that any repair, modification or installation work is carried out by unauthorized personnel. No consequential damages will be accepted either. The equipment conforms to Class IIb according to the Council Directive 93/42/EEC. This user manual has been written and reviewed originally in German and translated. Copyright Copyright 2005 Ziehm Imaging GmbH All rights reserved. Transmission or reproduction of this manual, exploitation and disclosure of its contents to third persons is not permitted without express written consent of the manufacturer. Infringements shall entitle to damage claims. Registered Trademarks This manual may contain the names of registered trademarks or brands, the use of which by third persons for their purposes may infringe the rights of their respective owners. Quality Standards This manual was produced in compliance with the quality principles of ISO The information provided in this manual may be updated at regular intervals and is subject to change without prior notice. Manufactured by: In the U.S.A.: Ziehm Imaging GmbH Ziehm Imaging, Inc. Donaustr Latham Street D Nuremberg (Germany) Riverside, CA info@ziehm-eu.com info@ziehm.com Rev. 07/2005

3 Table of Contents Table of Contents I 1 About this Manual System Overview Fields of application Features Options Options (U.S.A.) Optional accessories Optional accessories (U.S.A.) Parts of the system C-arm stand Monitor cart Monitor cart with 18.1" flat-screen monitors Monitor cart with CRT monitors Twin monitors Monitor settings on a with flat-screen monitors Integrated button panel Setting the brightness, contrast and backlight brightness Setting the menu language Restoring the factory settings Video output Safety Instructions General safety instructions X-rays Electromagnetic compatibility Protective grounding Equipotential grounding Laser radiation Environmental compatibility Putting the System into Service Unpacking the system Accessories Cable connections First power-up of the system Setting up the system Mechanical Handling Transport position C-arm stand transport position Monitor cart transport position Braking and steering the monitor cart Braking and steering the C-arm stand C-arm movements Orbital rotation I

4 Table of Contents Angulation Swiveling (panning) Horizontal movement Vertical movement Controls Vision Center control panel Elements of the control panel Controls in the Fluoroscopy and Subtraction operating modes Switches on the unit Hand switch and foot switch Switching the System On Preparing the system Switching the system on EMERGENCY STOP button Key switch Standard Fluoroscopic Operations Overview Fluoroscopy modes Continuous pulse fluoroscopy Digital radiography (snapshot) Manual exposure rate setting Fluoroscopy programs Anatomical programs Metal artifact correction function Reposition function High quality function Large patient function Screen display during radiation Dose area product Saving Printing the live monitor image Warning signals and faults Permanent warning during radiation Interval warning during radiation Temperature monitoring Error and alert messages Adjusting Live Images Overview Contrast and brightness settings for the CRT monitors Contrast and brightness adjustment of individual images (windowing) Filters Recursive filter Edge filter Stack filter Electronic image magnification Digital image zooming Grayscale inversion Collimation Iris collimator II

5 Table of Contents Slot collimator Virtual collimator Image swapping Image reversal and image rotation Horizontal and vertical image reversal Image rotation Data Management Organization of patient and image data Patient folders Generated patient folders Managing patient data Creating a new patient folder on the Entering patient data manually Modifying patient data Image data management Processing patient folders Finding and displaying a patient folder Activating a patient folder Browsing through the active patient folder Processing and outputting images in a patient folder Comparing saved images Making backup copies of patient folders Backup to USB storage device Backup to CD or DVD DICOM Functions Prerequisites Downloading patient data from a DICOM server Query Downloading a Worklist Downloading a Worklist for a specific time span Downloading a patient-specific Worklist Downloading a Worklist for a procedure step Saving images from one or several patient folders Saving and printing images and cine loops Saving or printing single cine loop images Importing images and cine loops from a DICOM server Cine Loops Overview Generating a cine loop Opening a saved cine loop Controlling and editing a cine loop during playback Processing and outputting saved cine loops Processing and outputting single cine loop images Subtraction Modes Overview Acquiring a DSA cine loop Acquiring an MSA image Acquiring an RSA image III

6 Table of Contents 13.5 Generating MSA and RSA images from a saved DSA cine loop Opening and postprocessing a DSA cine loop in an active patient folder Opening and postprocessing any DSA cine loop Editing a DSA cine loop Pixel shift Landmarking Post-Processing Images Overview Activating the post-processing functions Contrast and brightness settings for the CRT monitors Contrast and brightness adjustment of individual images (windowing) Edge filter Digital image zooming Grayscale inversion Image rotation Horizontal and vertical image reversal Digital collimation (image crop) Marking and deleting images Outputting images Measurements Measuring functions Calibrating Measuring a length or distance point measurement point measurement point ratio measurement Displayed Texts and Text Functions Overview Image information on the monitor Upper left corner of the monitor Upper right corner of the monitor Lower left corner of the monitor Lower right corner of the monitor Entering and editing text Image Documentation Overview Output to video printer Record and playback on video cassette recorder Laser Positioning Device Applications Direct Radiography Overview Fitting the film cassette holder Making a direct radiographic exposure IV

7 Table of Contents 20 System Configuration Overview Operation settings Autotransfer Autostore Displaying a crosshair Defining the start screen Cine loop settings Showing or hiding the native image Discarding the operation settings Basic settings Setting the system date and the system time Determining the live monitor Entering the hospital data Discarding the basic settings Monitor / Dose Storage media Floppy disk storage format Defining the USB device storage format Defining the CD / DVD storage format Deleting data from storage media C-Arm Power Assist (U.S. Option) Function Operating instructions Using the C-arm Power Assist Appendix A-1 A.1 Regular checks... A-1 A.1.1 Routine checks to be performed by the user... A-1 A.1.2 Consistency test according to national regulations... A-2 A.1.3 Checking the exposure rate control... A-2 A.1.4 Dose meter check (optional feature)... A-2 A.1.5 Checking the useful beam... A-4 A.1.6 Leakage in the cooling system... A-5 A.1.7 Gettering the image intensifier tube (n/a for FD)... A-5 A.1.8 Gain adjustment and pixel correction ( FD)... A-5 A.2 Cleaning, disinfection, sterilization... A-6 A.2.1 Cleaning... A-6 A.2.2 Disinfection... A-6 A.2.3 Sterilization... A-7 A.3 Faults... A-7 A.3.1 Types of faults... A-7 A Alerts during power-up... A-7 A Errors during power-up... A-7 A Alerts during operation... A-8 A Errors during operation... A-8 A.3.2 List of errors and alerts... A-8 A.4 Labels on the... A-16 A.5 Focal spot position... A-26 A A-26 A.5.2 FD... A-27 A.6 Heat capacity... A-28 V

8 Table of Contents A.7 Scattered radiation in the significant zone of occupancy... A-29 A A-29 A.7.2 FD... A-30 A.8 Dimensions... A-31 A.9 Technical data... A-35 A A-35 A.9.2 Laser positioning device... A-39 A.9.3 Dose measurement chamber... A-39 A.10 Labels on the (U.S.A.)... A-40 A.11 Technical data (U.S.A.)... A-48 A.12 Technical data (Japan)... A-51 Index i VI

9 About this Manual 1 This manual is designed to enable owners and operators of a Ziehm Vision or FD to operate the systems described herein safely and efficiently. Purpose of this manual and FD, software version 4. Scope of validity of this manual For several system options, separate operating instructions are available. They are supplied with the system, provided that the system configuration includes the respective option. You will find a corresponding reference in the relevant sections of the manual. Separate operating instructions Typographical conventions In this manual, the following notations and formats will be used to highlight certain elements of the Vision Center control panel or the documentation itself: Element Format Example Vision Center elements (buttons, symbols and boxes), operating modes, functions Bold Post Process Cross-references Steps of a procedure Italic, preceded by an arrow Preceded by a Ch. 20, p Press the OK button. Table 1-1 Notations and formats used in this manual 1-1

10 1 About this Manual Hints and warnings The manual contains some information which must be observed in order to ensure the personal safety of operating staff and patients as well as to avoid damage to property. All such information is highlighted as follows: WARNING This is the highest level of risk. Personal injury or damage to property may occur if the operator does not observe the instructions provided here. CAUTION This means that a situation exists which may require a decision or action on the part of the user for optimum equipment performance or to avoid a minor hazard. Note Notes are merely informative. Additional useful information and hints are provided for the operator here. 1-2

11 System Overview Fields of application The is a mobile C-arm X-ray image intensifier which is suitable for all surgical applications in traumatology, orthopedics, neurology, urology and cardiology, for use in gastroenterology and for all vascular applications. Applications The FD is suitable for more demanding vascular interventions requiring a high level of precision, e.g. in the field of neurology. FD 2.2 Features With its compact design and combined steering & braking system, the offers unrestricted mobility at the operating table, even if space is scarce. The easy adjustability of the ample C-arm and the perfect counterbalancing of the C-arm stand make it possible to access even the most difficult positions. Mobility Computer-controlled anatomical programs ensure optimal exposure rate and image quality control as well as high operating comfort. A Soft program for soft tissue visualization during foreign body localization and a Metal program for suppressing image flare resulting from the use of metal implants and surgical instruments complete the automatic functions. Anatomical programs The superior penetration capabilities of the digital high-frequency generator enable a significant reduction in the patient skin dose. Radiation-free collimation is provided by the system s Virtual Collimator. Radiation dose reduction 18" flat-screen monitors or optionally 1000 cd 2 CRT monitors with antireflection coating which are based on 150 Hz technology (U.S.A.: 90 Hz non-interlaced) guarantee flicker-free images. The advanced Full Frame Technology, which uses non-interlacing throughout the entire image processing chain, generates noise-free images without motion artifacts, even if the subject has moved. Image quality 2-1

12 2 System Overview FD The FD features a fully-digital image processing chain. The digital flat-panel detector ensures distortion-free images. Image adjustment Comprehensive real-time image processing functions (customizable noise and area filtering, electronic contrast and brightness adjustment, zooming, radiation-free horizontal and vertical image reversal, digital image rotation) ensure perfect adaptation of the image quality and orientation on the screen to the surgeon s needs. Further image processing functions are available for saved images (post-processing). Active Cooling The Active Cooling system allows for nearly unlimited fluoroscopy times, being often indispensable e.g. in cardiac and vascular surgery. Image management A patient-based image management system providing a 16-image mosaic view and menu-controlled user guidance guarantees efficient image data handling. Documentation and output For documentation purposes, a video printer and a video cassette recorder are available. For filmless archiving, the following devices are available: Floppy disk drive CD writer or DVD writer USB port Images can be stored in the following formats: PC-compatible BMP format (floppy disk) PC-compatible TIF format PC-compatible JPEG format with reduced resolution and reduced color depth DICOM format DICOM format with reduced resolution and reduced color depth Multimedia format: Video CD format (CD) or MPEG2 format (DVD). The system documents not only patient-related data, but also imagerelated data (e.g. the fluoroscopy parameters). In addition, all systems have a video output. 2-2

13 2 System Overview The optional DICOM 3.0 interface (Ziehm NetPort) enables integration into any network supporting DICOM, e.g. PACS. Thanks to Primary Capture support, the original fluoroscopic images can be archived without the changes which may have been applied to them later. The following DICOM Classes are available: Print, Storage (including multiframe capability), Media, Worklist, Query/Retrieve and Verification. It is possible to connect and configure several DICOM servers for each DICOM Class. For more information on DICOM, please refer to our DICOM Conformance Statement included in the Technical Manual. Networkability 2-3

14 2 System Overview 2.3 Options This manual describes a system with maximum configuration. The system configuration chosen by you may not contain all options and functions described here. The following options can be integrated into the system upon request: DICOM 3.0 interface Ziehm NetPort (Primary Capture) Depending on the chosen system configuration, the following DICOM Classes are supported: Print Class Storage Class including multiframe capability Media Class Worklist Class Query/Retrieve Class Verification Class Dose measurement chamber for measuring the dose area product Laser positioning device on the generator and/or image intensifier or digital flat-panel detector Key switch EMERGENCY STOP button Connection for external separate radiation warning lamp (including software) Codonics laser printer (EP 1660) Codonics laser printer (NP 1660 MD) S-VHS video cassette recorder with automatic recording control (Sony SVO-9500MDP) Video printer Sony UP-895 or UP-960 (for printout on paper) or UP-980 (for printout on paper or transparent film) CRT monitors USB port CD writer or DVD writer 2-4

15 2 System Overview 2.4 Options (U.S.A.) This manual describes a system with maximum configuration. The system configuration chosen by you may not contain all options and functions described here. The following options can be integrated into the system upon request: Hardware options: CD writer Video printer Sony UP-895 or UP-960 (for printout on paper) or UP-980 (for printout on paper or transparent film) Codonics laser printer (EP 1660) Laser positioning device on the generator and/or image intensifier Dose measurement chamber for measuring the dose area product Vision Center located in the monitor cart Optional functions: Measurements DSA CINE with 5/10/15/30 frames per second (30 frames per second only with DSA option) Additional image storage: 5,000/10,000/20,000/50,000 images (50,000 images only with DSA option) DICOM 3.0 interface Ziehm NetPort (Primary Capture) Depending on the chosen system configuration, the following DICOM Classes are supported: Print Class Storage Class including multiframe capability Media Class Worklist Class Query/Retrieve Class (patient level) Query/Retrieve Class (study level) Query/Retrieve Class (series level) Query/Retrieve Class (image level) Verification Class Dose area product display 2-5

16 2 System Overview 2.5 Optional accessories The following accessories are optionally available for the : Sterile disposable covers for all sizes Hand surgery table (n/a for FD) Universal film cassette holder (n/a for FD) Foot switch cover 2.6 Optional accessories (U.S.A.) Hand surgery table Universal film cassette holder C-arm power assist ( Ch. 21, p. 21-1) 2-6

17 2 System Overview 2.7 Parts of the system C-arm stand C-arm Image intensifier with integrated CCD camera Vision Center control panel C-arm handle Horizontal carriage Lifting column Steering & braking lever Handle Hand switch Coupling cable connection Swivel arm Cassette holder X-ray generator Cable guards Fig. 2-1 Mobile C-arm stand of 2-7

18 2 System Overview FD C-arm Digital flat-panel detector Vision Center control panel C-arm handle Horizontal carriage Lifting column Steering & braking lever Handle Hand switch Swivel arm X-ray generator Coupling cable connection Cable guards Fig. 2-2 Mobile C-arm stand of ( FD) 2-8

19 2 System Overview Monitor cart Monitor cart with 18.1" flat-screen monitors Radiation warning lamp Front view Flat-screen monitors Button panels for monitor settings Floppy disk drive CD writer or DVD writer USB port Button panels for monitor settings Control panel Video printer Foot lever for braking and direction locking Foot lever for braking and direction locking Fig. 2-3 Monitor cart with 18.1" flat-screen monitors, front view Rear view Coupling cable support DICOM port (optional) Power cable support TX/RX connection Power supply connection VIDEO OUT DICOM port (optional) Coupling cable connection Equipotential grounding Fig. 2-4 Spare earth ground connection Monitor cart with 18.1" flat-screen monitors, rear view 2-9

20 2 System Overview ON OFF On the rear side of each flat-screen monitor, there is an ON/OFF switch. CAUTION Always set the ON/OFF switches on the flat-screen monitors to ON in order to ensure that the monitors are switched on automatically during power-up of the system. Movement of the flat-screen monitors The flat-screen monitors are mounted on a pivot and can be swiveled by approx. 15 to the right or to the left Monitor cart with CRT monitors Front view Radiation warning lamp Twin monitors Floppy disk drive CD writer or DVD writer USB port Control panel Video printer Foot lever for braking and direction locking Foot lever for braking and direction locking Fig. 2-5 Monitor cart with CRT monitors, front view 2-10

21 2 System Overview Rear view Coupling cable support DICOM port (optional) Power cable support TX/RX connection Power supply connection VIDEO OUT DICOM port (optional) Coupling cable connection Equipotential grounding Spare earth ground connection Fig. 2-6 Monitor cart with CRT monitors, rear view Twin monitors On the, the left monitor has been factory-set as the live monitor and the right monitor as the reference monitor. During operation, the following images will be displayed on the screens: Live monitor: Live images and saved images, both as full-screen image Reference monitor: Thumbnail mosaic, reference images at fullscreen size Monitor assignment Note To avoid confusion, the neutral terms live monitor and reference monitor are used throughout this manual, regardless of your custom setting. You can change the monitor assignment in the Configuration operating mode under Basic Settings ( Ch , p. 20-9). You can customize the contrast and brightness settings of the 18.1" flatscreen monitors ( Ch , p. 2-12) and of the CRT monitors ( Ch. 9.2, p. 9-2 or Ch. 14.3, p. 14-4). Changing the monitor settings 2-11

22 2 System Overview Monitor settings on a with flat-screen monitors Monitor settings You can change the following monitor settings yourself: Brightness Contrast Backlight brightness Menu language for monitor settings In addition, you can restore the factory settings. The factory-set menu language is English. The following monitor settings cannot be changed by the user: Video input (Inputs) Gamma Picture settings (Picture), e.g. vertical position/horizontal position, sharpness, scaling Menu setup (Setup), e.g. menu lock (exception: language setting) If you want to change one or more of these monitor settings, please contact your service engineer Integrated button panel Each flat-screen monitor ( Fig. 2-3, p. 2-9) has an integrated button panel with six buttons, which are used for accessing the monitor setting menus. Fig. 2-7 Integrated button panel of the flat-screen monitor Setting the brightness, contrast and backlight brightness Brightness To set the brightness of the monitor, do the following: Press the Brightness/Contrast button. The Brightness menu appears on the screen. 2-12

23 2 System Overview Press the + or arrow button to increase or decrease the screen brightness. The settings become immediately valid on the monitor. After a few seconds, the Brightness menu disappears automatically. To set the contrast of the monitor, do the following: Press the Brightness/Contrast button twice. The Contrast menu appears on the screen. Contrast Press the + or arrow button to increase or decrease the contrast. The settings become immediately valid on the monitor. After a few seconds, the Contrast menu disappears automatically. To set the backlight brightness of the monitor, do the following: Press the Brightness/Contrast button three times. The Backlight Brightness menu appears on the screen. Backlight brightness Press the + or arrow button to increase or decrease the backlight brightness. The settings become immediately valid on the monitor. After a few seconds, the Backlight Brightness menu disappears automatically. 2-13

24 2 System Overview Note Lowering the backlight level will increase the backlight lifetime Setting the menu language The factory-set menu language is English. You can choose one of the following languages as menu language: German French Italian Spanish Dutch Swedish To define the menu language, do the following: Press the Menu button. The menu selection window appears on the screen. Select the Setup menu with the help of the + or arrow buttons. Move to the Language menu item with the help of the Scroll button. Press the + arrow button until the desired language is displayed. All menus and menu items are displayed immediately in the chosen language. 2-14

25 2 System Overview Press the Menu button. The menu selection window disappears Restoring the factory settings After having changed the monitor settings, you may restore the factoryset values at any time. To restore the factory settings, do the following: Press the Menu button. The menu selection window opens. Select the Defaults menu with the help of the + or arrow buttons. Press the Scroll button. The Factory Defaults menu item is selected. Press the + arrow button. The menu selection window disappears. All settings are reset to the factory values. 2-15

26 2 System Overview Video output BNC socket A BNC socket which is used for video connection (VIDEO OUT) is located on the rear of the monitor cart. VIDEO OUT The VIDEO OUT socket supplies a CCIR video signal of the live monitor image. The fluoroscopic image (live or stored) is available there for further processing by a video cassette recorder, an external monitor, a video printer, etc. WARNING Supplementary equipment used in combination with the must comply with the safety requirements according to IEC and/or IEC or furnish proof of an equivalent degree of safety. To ensure CE conformity, these components must have a CE approval in accordance with Council Directive 93/42/EEC. In addition, a declaration in compliance with Article 12 of the said directive must be provided. For components without CE approval, a conformity assessment procedure is obligatory. If you combine the with equipment which does not comply with these requirements, the safety of the whole system is no longer given and the warranty will become invalid. 2-16

27 Safety Instructions General safety instructions WARNING You must be familiar with the contents of this user manual in order to be able to operate the system as intended. Study this user manual thoroughly before operating the system. It is important to observe all directions, safety instructions and warnings! WARNING Supplementary equipment used in combination with the must comply with the safety requirements according to IEC and/or IEC or furnish proof of an equivalent degree of safety. To ensure CE conformity, these components must have a CE approval in accordance with Council Directive 93/42/EEC. In addition, a declaration in compliance with Article 12 of the said directive must be provided. For components without CE approval, a conformity assessment procedure is obligatory. If you combine the with equipment which does not comply with these requirements, the safety of the whole system is no longer given and the warranty will become invalid. Only properly trained personnel are allowed to operate the system. Operation The system may only be operated by properly trained personnel under the direction of a physician. Operation (U.S.A.) 3-1

28 3 Safety Instructions Assembly and service Only authorized personnel are allowed to assemble the system and to provide technical service. The necessary qualifications can only be obtained by attending a training course provided by the manufacturer. CAUTION Always observe the relevant regulations of the country of installation for putting the system into service, training of personnel and maintenance. WARNING Never use the system if you suspect any electrical or radiationgenerating components to be defective! WARNING Never pull at the power cable or coupling cable of the monitor cart in order to move the cart to another position. Otherwise severe equipment damage may result. 3.2 X-rays General The system produces X-rays. If you do not observe the safety measures and precautions required by your local radiation protection regulatory body, these X-rays can be hazardous both to operating staff and other persons within the radiation zone of occupancy. WARNING The system may only be operated by personnel who has undergone radiological training. WARNING (U.S.A.) The system may only be operated by properly trained personnel under the direction of a physician. CAUTION The relevant safety regulations of the country of installation must be observed. 3-2

29 3 Safety Instructions Staff members who stay within the radiation controlled area must wear X- ray protective clothing. Protection of staff The radiation controlled area depends upon the size of the image intensifier installed and has the following radius: 23 cm i.i.: 4 m 31 cm i.i.: 4 m ( Fig. A-12, p. A-29) Digital flat-panel detector: 4 m ( Fig. A-13, p. A-30) WARNING In order to avoid unintentional radiation, the foot switch must be hung up on the foot switch support when the system is switched on, but not in use. To minimize the radiation burden of the patient, you must keep the focusskin distance as large as possible. The generator design guarantees a minimum focus-skin distance of 20 cm. Protection of the patient WARNING In order to avoid unintentional radiation, the foot switch must be hung up on the foot switch support when the system is switched on, but not in use. WARNING When you initiate radiation and no live image is displayed, although all necessary settings have definitely been made, please contact your after-sales service center! 3.3 Electromagnetic compatibility Medical electrical equipment requires special precautionary measures with respect to EMC and must be installed and put into service in accordance with the EMC guidelines contained in the accompanying documents. Portable and mobile RF communications equipment may interfere with medical electrical equipment. All operating modes of the system have been considered in the EMC tests. There are no exceptions to the rules. 3-3

30 3 Safety Instructions Only conductors, connecting cables and accessories that are specified by the manufacturer may be used. WARNING Using components other than those specified may result in increased electromagnetic emissions or reduced electromagnetic immunity. Please observe also the attached document Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC ! 3.4 Protective grounding The system must be connected only to power systems having a separate ground connection. 3.5 Equipotential grounding Heart and brain examinations If you use the system in combination with other equipment for examinations of the heart or brain or the surrounding anatomical regions, equipotential grounding is required for patient and operating staff safety (IEC :1992/A1:1995). 3-4

31 3 Safety Instructions 3.6 Laser radiation As an option, the system may be equipped with a laser positioning device at the image intensifier and/or generator. The laser positioning device uses diode laser modules which emit laser radiation. Do not under any circumstances look directly at the laser beam or any scattered laser radiation either with the naked eye or with optical instruments. The laser positioning device is a Class 2M laser product according to IEC : Make sure to comply with all operating safety precautions when using the laser positioning device. The maximum output of continuous laser radiation, measured at the beam exit, is <1 mw. The wavelength of the emitted radiation is 635 nm. Laser positioning device WARNING LASER RADIATION DO NOT LOOK INTO THE BEAM! Do not look directly with optical instruments into the laser beam apertures, since doing so can be hazardous to your eyes! Please observe the provisions of IEC :2001, Section 3, User s Guide for operation of the laser positioning device. The laser positioning device is maintenance-free. Any adjustment or repair which might become necessary must be carried out by the manufacturer or a person who has been authorized to do so by the manufacturer. Maintenance Laser beam apertures Laser beam apertures Fig. 3-1 Laser beam apertures on the image intensifier (left) and on the generator (right) () 3-5

32 3 Safety Instructions Laser beam apertures Laser beam aperture Laser beam aperture Fig. 3-2 Laser beam apertures on the digital flat-panel detector (left) and on the generator (right) ( FD) 3.7 Environmental compatibility The system does not produce any waste during operation. When the system has reached the end of its useful service life, the relevant waste disposal regulations must be observed. 3-6

33 Putting the System into Service Unpacking the system Detailed instructions of how to unpack and assemble the system are supplied with the system. Detailed information WARNING Only authorized personnel ( p. 1-2) are allowed to unpack and assemble the system. During assembly, the system may be handled only by trained personnel who have studied the contents of Ch. 4, Putting the System into Service and Ch. 5, Mechanical Handling. In case of major differences in temperature, all parts of the system must have reached room temperature before the system is put into service in order to avoid damage to the system as a result of condensation. Room temperature WARNING The cooling tank may have been emptied before shipping for transport temperatures below 0 C. In this case, you must refill the cooling tank with water with the help of the filler and vent hoses before putting the system into service. WARNING Do not operate the system until the equipment has reached a safe operating temperature of +15 C to +35 C with no condensation present. Otherwise severe equipment damage may result. 4-1

34 4 Putting the System into Service 4.2 Accessories Depending on the integrated options, the following accessories are included in the scope of delivery: All systems Options Accessory item Qty. User Manual 2 Technical Manual 1 Specifications and Certificates 1 (n/a for the U.S.A.) Coupling cable (7.5 m) 1 Equipotential grounding cable (6 m) 1 Active Cooling Filler and vent hose (1.5 m) 2 Instructions for Filling of Cooling Agent into 1 Video printer Operating instructions for video printer 1 Printer paper 1 roll Printer transparent film 1 roll (only Sony UP-980) Video cassette recorder Operating instructions for video cassette recorder Video cassette S-VHS (240 min.) 1 CD writer CD (640 MB) 1 DVD writer DVD (4.7 GB) 1 USB port USB storage device 1 DICOM RJ45 interface with Cat.5 patch cable 1 (10 m) Fiber-optic connection (FOC): ST coupling, 10base-FL or 100base-FX 1 1 Table 4-1 Accessories 4-2

35 4 Putting the System into Service 4.3 Cable connections Before switching on the system for the first time, or after each transport, you must establish different cable connections. General To connect the various parts of the system, do the following: Unwind the coupling cable from the upper cable support on the back of the monitor cart ( Fig. 2-6, p or Fig. 2-4, p. 2-9). Plug the coupling cable connector into the socket located at the side of the C-arm stand and lock the connector ( Fig. 2-1, p. 2-7). Make sure that a suitable supply voltage is available and that the socket-outlet is properly grounded and fused. Check the power plug on the monitor cart power cable ( Fig. 2-6, p or Fig. 2-4, p. 2-9) and the socket-outlet for compatibility. Connect the system to the power supply. WARNING Never connect the monitor cart and C-arm stand when the monitor cart is already connected to the power supply or switched on. Damage to the electronics of the system cannot be excluded if this warning is ignored! 4.4 First power-up of the system Make sure that the inclination of the system does not exceed 5 from the level in operating position. Preparation Ensure that all electrical connections are properly established ( Ch. 4.3, p. 4-3). Put on suitable protective clothing. Switch on the system. The buttons for switching the system on and off are located on the monitor cart behind the control panel on the left and on the left side of the C-arm stand next to the handle. Each of the two buttons switches on or off both system components simultaneously. The default settings after power-up vary from system to system, according to the customer-specific setup. 4-3

36 4 Putting the System into Service CAUTION with USB port: Do not plug the USB storage device into the USB interface until the system has fully completed its power-up sequence. Note Due to background radiation, the Dose Area Product display (if enabled) may indicate some small value after power-up of the system. Note As part of the power-up sequence, the radiation warning lamp may light up. This is a system test and does not mean that radiation is released. 4.5 Setting up the system Configuration You have the possibility to adjust various basic and operation settings so as to meet your special working requirements. If these settings have not already been made at the factory, you can make them yourself in the Configuration operating mode ( Ch. 20, p. 20-1). Entering the hospital data In order to avoid having to enter the invariable hospital data (i.e., name of the hospital, department and doctor) again and again for each new patient, you can record this data once in the Configuration operating mode under Basic Settings ( Ch , p ). Each time you create a new patient folder ( Ch , p. 10-3), the hospital data which has been entered there will appear automatically in the corresponding fields. 4-4

37 Mechanical Handling Transport position For safety reasons, you must return both the C-arm stand and the monitor cart to their respective transport position before transporting them. General C-arm stand transport position To return the C-arm stand to its transport position, do the following: How to proceed Wind the foot switch cable onto the foot switch support and hang up the foot switch there. Rotate the C-arm orbitally until the image intensifier is positioned directly above the generator and secure it with the relevant brake ( Fig. 5-1, p. 5-2 and Fig. 5-5, p. 5-7). Put the swivel arm of the C-arm into an upright position and secure it with the relevant brake ( Fig. 5-1, p. 5-2 and Fig. 5-7, p. 5-8). Swivel the horizontal carriage into a central position and secure it with the relevant brake ( Fig. 5-1, p. 5-2 and Fig. 5-7, p. 5-8). Retract the horizontal carriage completely and secure it with the relevant brake ( Fig. 5-1, p. 5-2 and Fig. 5-11, p. 5-10). Lower the lifting column completely ( Fig. 5-1, p. 5-2 and Fig. 5-13, p. 5-12) using the UP/DOWN buttons. Switch off the system and disconnect the power cable from the power supply. Unlock the coupling cable connector on the C-arm stand and unplug the connector. Release the parking brake by lifting the steering & braking lever ( Fig. 5-1, p. 5-2). If you want to move the C-arm stand over very soft or uneven floors (e.g. doorways), raise the cable guards on the wheels. 5-1

38 5 Mechanical Handling C-arm + brake Swivel arm + brake Horizontal carriage + brake Swivel brake Lifting column Steering & braking lever Cable guards Fig. 5-1 C-arm stand transport position () C-arm + brake Swivel arm + brake Horizontal carriage + brake Swivel brake Lifting column Steering & braking lever Cable guards Fig. 5-1 C-arm stand transport position ( FD) Monitor cart transport position To return the monitor cart to its transport position, do the following: Wind the power cable onto the lower cable support on the back of the monitor cart. Wind the coupling cable onto the upper cable support on the back of the monitor cart. If applicable, disconnect the equipotential grounding cable from the system ground. 5-2

39 5 Mechanical Handling Unlock the parking brake by pushing the foot levers on the front wheels with your foot into the middle position. Coupling cable support Power cable support Fig. 5-2 Monitor cart transport position CAUTION Do not move the system over floors with an inclination of more than 10 from level during transport. This applies to both the C-arm stand and the monitor cart. Exercise extreme caution when moving the mobile C-arm stand and the monitor cart over rough surfaces such as tile flooring, pavement, asphalt or carpet. Take care that the cable guards do not drag and the wheels do not catch or tilt causing damage to the equipment. 5-3

40 5 Mechanical Handling 5.2 Braking and steering the monitor cart Brake On both front wheels of the monitor cart there is a foot lever which serves for locking and releasing the brake. Foot lever for locking the wheel Fig. 5-3 Monitor cart front wheel You can push the foot lever with your foot into three different positions: Lever in middle position: The wheels can move freely, the brake is released Lever in lower position: The wheels are locked, the brake is locked as well Lever in upper position: You can move the monitor cart forward and backward. Steering To steer the monitor cart, use the two lateral handles. 5-4

41 5 Mechanical Handling 5.3 Braking and steering the C-arm stand The C-arm stand has a combined steering & braking lever. It is located at the rear end of the C-arm stand ( Fig. 2-1, p. 2-7). Steering & braking lever The C-arm stand parking brake operates as follows: Steering & braking lever lowered: Parking brake Rear wheels are locked Steering & braking lever raised: Rear wheels can move freely To steer the C-arm stand, do the following: Steering Lift the steering & braking lever and turn it until reaching the desired position. The lever can be turned freely; however, detents are placed at 90 increments. The rear wheels will always stay parallel to one another aligned exactly in parallel with the steering & braking lever. To maneuver the C-arm stand freely, ensure that the steering & braking lever has engaged in its central position, pointing directly backward from the unit ( Fig. 5-4, p. 5-6, left). To move the C-arm stand in an exactly-defined direction, rotate the steering & braking lever until it points toward the desired direction ( Fig. 5-4, p. 5-6, right). Push the C-arm stand in the desired or predefined direction using the lateral handles, or use the hand rail around the image intensifier to pull the C-arm stand. CAUTION Release the parking brake only to move or position the C-arm. 5-5

42 5 Mechanical Handling Fig. 5-4 C-arm stand steering (schematic representation, view from above) 5.4 C-arm movements Mechanical brakes The C-arm can be moved in virtually any plane. For each movement, a separate brake is available, allowing you to secure the C-arm in any position. To release the corresponding brake, turn it counter-clockwise. The limit stop of the brake handles can be adjusted individually. To do so, lift the spring-loaded brake handle, turn it until reaching the desired limit stop position and release it to re-engage it at the new position. CAUTION Before moving the C-arm, make sure that there is nobody within its range of movement. 5-6

43 5 Mechanical Handling WARNING Release the mechanical brakes only for positioning. Take care to always seize the C-arm at its handle during any adjustment in order to prevent the C-arm from hitting the respective limit stop at full speed! Take care not to place your hand in the C-arm guide rails when adjusting the C-arm. Make sure that all mechanical brakes are locked when transporting the C-arm stand! Orbital rotation The C-arm can be rotated orbitally by 115 (optionally 135 for 23 cm i.i.): 90 from vertical to horizontal position and +25 (optionally +45 ) forward. A scale with 5 divisions on the outside of the C-arm as well as a mechanical detent at the zero position are provided to facilitate precise positioning. Angulation brake Orbital rotation brake Fig. 5-5 Orbital rotation of the C-arm () 5-7

44 5 Mechanical Handling Angulation brake Orbital rotation brake Fig. 5-6 Orbital rotation of the C-arm ( FD) Angulation The C-arm can be rotated by ± 225 in the vertical plane around the horizontal axis (i.e., the horizontal carriage). A scale with 10 divisions is provided at the pivot joint of the horizontal carriage (except on 31 cm i.i. systems) to facilitate precise positioning. Fig. 5-7 Angulation of the C-arm () 5-8

45 5 Mechanical Handling Fig. 5-8 Angulation of the C-arm ( FD) The angulation brake is located on the horizontal carriage ( Fig. 5-5, p. 5-7) Swiveling (panning) The C-arm can be swiveled 10 to the left or to the right around the vertical axis of the lifting column. Swivel brake Fig. 5-9 Swiveling (panning) of the C-arm (, view from above) 5-9

46 5 Mechanical Handling Swivel brake Fig Swiveling (panning) of the C-arm ( FD, view from above) Horizontal movement You can move the C-arm forward and backward by 22 cm in the horizontal plane by means of the horizontal carriage. A scale with 1 cm divisions is provided to facilitate precise positioning. Horizontal movement brake Fig Horizontal movement of the C-arm () 5-10

47 5 Mechanical Handling Horizontal movement brake Fig Horizontal movement of the C-arm ( FD) Vertical movement The C-arm can be moved up and down by 43 cm. This movement is motorized. A scale with 1 cm divisions is provided on the lifting column to facilitate precise positioning. The UP/DOWN buttons are on the C-arm stand next to the lateral handles. To move the C-arm up or down, you must press and hold down the corresponding UP/DOWN button. CAUTION Before moving the C-arm up or down, make sure that it does not collide with any persons or objects! 5-11

48 5 Mechanical Handling UP/DOWN buttons Fig Vertical movement of the C-arm () UP/DOWN buttons Fig Vertical movement of the C-arm ( FD) 5-12

49 Controls Vision Center control panel The Vision Center control panel is designed as a touch screen. For system operation, just press the desired button or option directly on the screen. Depending on the selected function, other controls (buttons, input boxes, displays, etc.) will appear on the screen. Both the C-arm stand and the monitor cart have a control panel. The screens on both control panels are identical, enabling you to use any of them for system operation Elements of the control panel Warning symbols Selected operating mode Title bar Displays Dynamic control area Buttons Buttons Tabs for operating mode selection Fig. 6-1 Elements of the control panel There are three types of buttons: Buttons with a gray background: When you press one of these buttons, an action is executed immediately on the monitor, or a mode is activated. If a certain mode is active, the corresponding button is highlighted in yellow. Buttons with a gray background and a purple bar at the top: When you press one of these buttons, new controls appear in the dynamic control area, allowing you to make further settings. 6-1

50 6 Controls Buttons with a gray background and a green bar at the top: When you press one of these buttons, another mode or sub-mode is activated Controls in the Fluoroscopy and Subtraction operating modes Fluoroscopy operating mode In the Fluoroscopy operating mode, you can make different settings for fluoroscopies: 4$ 4% 5) 4^ 4& 4* 4( 5! 2& 3) 3# 2* 3! 3$ 2( 3@ 3% B E H 1# 1$ 1* 2! 2$ C F I 1) J 1% 1^ 1( 2@ 2^ D G 1! 1@ 1& 2) 2# 2% 3^ 3& 3* 3( 4) 4! 4@ 4# Fig. 6-2 Control panel in the Fluoroscopy operating mode Control no. B C D Symbol(s) Meaning Continuous Pulse Fluoroscopy Activates the continuous pulse fluoroscopy mode and displays the pulse rate setting controls in the dynamic control area. High Quality Activates the high quality supplementary function. Caution: Reduce radiation time! Snapshot Activates the snapshot mode. Table 6-1 Controls in the Fluoro operating mode 6-2

51 6 Controls Control no. E F G H I J Symbol(s) Meaning Manual Exposure Rate Setting Enables manual setting of tube voltage and tube current. Caution: Use only in exceptional cases! Large Patient Activates the large patient supplementary function. Cine Activates or deactivates the cine loop mode. Image Swapping Swaps the images between the live and reference monitors. Rotate Image CW Rotates the image in clockwise direction. FD: As soon as the image is rotated, it assumes a circular shape. Rotate Image CCW Rotates the image in counter-clockwise direction. FD: As soon as the image is rotated, it assumes a circular shape. 1) Rotate Image to 0 Resets the angle of rotation of the image in one step to 0. 1! Reverse Up/Down Mirrors the image vertically around the horizontal axis. 1@ Reverse Left/Right Mirrors the image horizontally around the vertical axis. 1# Close Iris Collimator Closes the iris collimator. 1$ Open Iris Collimator Fully Fully opens the iris collimator in one step. Table 6-1 Controls in the Fluoro operating mode (cont.) 6-3

52 6 Controls Control no. Symbol(s) Meaning 1% Close Vertical Slot Collimator Closes the slot collimator. When you press the Close Vertical Slot Collimator button, the buttons for opening and rotating the collimator appear on the control panel: Open Vertical Slot Collimator Opens the slot collimator. 1^ Rotate Vertical Slot Collimator CW Rotates the slot collimator in clockwise direction. Rotate Vertical Slot Collimator CCW Rotates the slot collimator in counterclockwise direction. Open Vertical Slot Collimator Fully Fully opens the vertical slot collimator in one step. 1& Rotate Vertical Slot Collimator to 0 Resets the vertical slot collimator in one step to 0. 1* Bones Activates the anatomical program for visualizing any part of the skeleton. 1( Heart Activates the anatomical program for visualizing the heart and thorax region. 2) Abdomen Activates the anatomical program for visualizing the abdominal region. 2! Metal Activates the metal artifact correction supplementary function. 2@ Reposition Activates the reposition supplementary function. 2# Soft Activates the anatomical program for visualizing soft tissues. 2$ Up Arrow Displays the image with the next higher number in the active patient folder at full-screen size. Table 6-1 Controls in the Fluoro operating mode (cont.) 6-4

53 6 Controls Control no. 2% Down Arrow Displays the image with the next lower number in the active patient folder at full-screen size. 2^ Symbol(s) Meaning Save Saves the active image to the hard disk. 2& Laser Activates or deactivates the laser positioning device(s). 2* Filter Shows or hides the controls for raw image processing (recursive filter, edge filter, stack filter) in the dynamic control area. 2( VCR Displays the controls for operating the video cassette recorder in the dynamic control area. 3) Magnify (n/a for FD) Shows or hides the controls for setting the image intensifier s electronic magnification in the dynamic control area. The buttons always show the current image magnification level. 3! Zoom Shows or hides the controls for setting the zoom function in the dynamic control area. 3@ Contrast/Brightness Shows or hides the monitor setting controls and the contrast and brightness (windowing) controls in the dynamic control area. 3# Print Live Monitor Image Prints the image displayed on the live monitor on the video printer. 3$ Text Activates the text mode. 3% Grayscale Inversion Displays the active (positive) image with a negative grayscale or vice versa. Table 6-1 Controls in the Fluoro operating mode (cont.) 6-5

54 6 Controls Control no. 3^ Symbol(s) Meaning Fluoro Activates the Fluoroscopy operating mode, which is used for performing standard fluoroscopies. 3& Subtraction Activates the Subtraction operating mode, which is used for generating DSA, MSA and RSA images. 3* Radiography (n/a for FD) Activates the Radiography operating mode, which is used for making direct radiographies. 3( Patient Activates the Patient operating mode, which is used for managing patient data. 4) Post Proc. Activates the Post Process operating mode, which is used for postprocessing saved images. 4! Measure Activates the Measurement operating mode, which is used for measuring distances and angles in saved images. Archive Activates the Archive operating mode, which is used for managing saved images. 4# Config Activates the Configuration operating mode, which is used for adjusting the operation settings and the basic settings and for deleting data on storage media. 4$ Voltage display Shows the automatically determined or manually set tube voltage in kv. After fluoroscopy, the last kv value remains stored. Table 6-1 Controls in the Fluoro operating mode (cont.) 6-6

55 6 Controls Control no. 4% Current display Shows the automatically determined tube current in ma. After fluoroscopy, the last ma value remains stored. 4^ Symbol(s) Meaning Pulsewidth % display Shows the current pulse width. 4& Pulses /s display Shows the current pulse rate. 4* Dose Area Product display Shows the dose area product for the active patient folder in cgy cm 2, if the system is equipped with a dose measurement chamber. 4( Radiation Time display Shows the accumulated radiation time for fluoroscopies and direct radiographies for the active patient folder in minutes and seconds. 5) Temperature symbol Shows the thermal conditions in the generator. 5! X-ray symbol Lights up yellow during X-ray exposure (fluoroscopy and direct radiography). Table 6-1 Controls in the Fluoro operating mode (cont.) 6-7

56 6 Controls Subtraction operating mode The Subtraction operating mode screen is to a large extent identical to the Fluoroscopy operating mode screen. Instead of the Soft and Metal buttons, it shows the DSA button: 5@ Fig. 6-3 Control panel in the Subtraction operating mode Control no. Symbol(s) Meaning 5@ DSA Displays the controls for the DSA subtraction mode settings in the dynamic control area. Table 6-2 Additional controls in the Subtraction operating mode Unavailable controls Controls which are not required in a certain operating situation (e.g. playback of a saved cine loop) are automatically locked, i.e. they are not available. 6-8

57 6 Controls In the Patient, Text, Archive Search, Archive Backup and Configuration operating modes, an alphanumeric keypad is displayed, allowing you to enter texts. Alphanumeric keypad Fig. 6-4 Alphanumeric keypad displayed on the Vision Center control panel Note It is not possible to press two keys on the keypad simultaneously. To combine a key with the Shift key, first press and release the Shift key and then the desired key. To generate uppercase letters and special characters, first press and release the Shift key and then the corresponding key. The Shift key is valid for one subsequent letter or special character. Uppercase letters and special characters If you want to type several consecutive uppercase letters or special characters, press the Caps Lock key before entering the letters or characters. To deactivate the Caps Lock mode, press the Caps Lock key once again. To generate a blank space, press the Space key. 6.2 Switches on the unit Both the C-arm stand and the monitor cart have buttons for switching the system on or off ( Fig. 7-1, p. 7-2). On the C-arm stand, there are two buttons with arrows (UP/DOWN), which are used for lifting and lowering the C-arm on its mobile stand. 6-9

58 6 Controls 6.3 Hand switch and foot switch General The is equipped with a hand switch and a two-pedal foot switch. Hand switch Fig. 6-5 Hand switch Two-pedal foot switch. Fig. 6-6 Two-pedal foot switch Radiation is initiated either with the hand switch or the fluoroscopy pedal of the foot switch. The default pedal assignment of the two-pedal foot switch is as follows: Left pedal: Fluoroscopy Right pedal: Save image ( Ch. 8.7, p. 8-10) Note The foot switch pedals are able to be assigned with customer-specific functions. If this is the case, the respective functions are indicated on labels on the foot switch itself and on the C-arm stand. 6-10

59 Switching the System On Preparing the system Before switching on the system, e.g. after a transport, you must connect the two system components to each other and also connect the whole system to the power supply. General WARNING Never connect the monitor cart and C-arm stand when the monitor cart is already connected to the power supply or switched on. Damage to the electronics of the system cannot be excluded if this warning is ignored! To prepare the unit, do the following: Unwind the coupling cable from the upper cable support on the back of the monitor cart ( Fig. 2-6, p or Fig. 2-4, p. 2-9). Plug the coupling cable connector into the socket located at the side of the C-arm stand and lock the connector ( Fig. 2-1, p. 2-7). Make sure that a suitable supply voltage is available and that the socket-outlet is properly grounded and fused. Check the power plug on the monitor cart power cable ( Fig. 2-6, p or Fig. 2-4, p. 2-9) and the socket-outlet for compatibility. Connect the system to the power supply. Make sure that the inclination of the system does not exceed 5 from the level in operating position. Put on suitable protective clothing. 7-1

60 7 Switching the System On 7.2 Switching the system on Both the C-arm stand and the monitor cart have buttons for switching the system on or off ( Fig. 7-1, p. 7-2). Each of the two buttons switches on or off both system components simultaneously. Fig. 7-1 ON/OFF switches on the C-arm stand (left) and on the monitor cart (right) CAUTION with USB port: Do not plug the USB storage device into the USB interface until the system has fully completed its power-up sequence. Note Due to background radiation, the Dose Area Product display (if enabled) may indicate some small value after power-up of the system. Note As part of the power-up sequence, the radiation warning lamp may light up. This is a system test and does not mean that radiation is released. To switch on the system, do the following: Press the ON switch. The system is switched on. The ON switch is illuminated now. Customer-specific initial settings The default settings after power-up vary from system to system, according to the customer-specific setup. You may e.g. choose your preferred start screen yourself ( Ch , p. 20-5). Furthermore, you may choose to have a certain anatomical program and various live image settings ( Ch. 9, p. 9-1) preset as default after power-up. You cannot make these presettings yourself. Please contact your service engineer if you wish to make or modify the initial settings. 7-2

61 7 Switching the System On 7.3 EMERGENCY STOP button There is an EMERGENCY STOP button on both the C-arm stand and the monitor cart of the, enabling you to switch off all electrical functions of the unit in case of emergencies. To switch off the system in an emergency situation, do the following: Fully press down the EMERGENCY STOP button. The EMERGENCY STOP button is locked in this position. The system switches off immediately. All electrical functions of the system are disabled. To unlock the EMERGENCY STOP button, press the red knob of the EMERGENCY STOP button with a slight twist. The unit remains switched off. You can switch the unit back on with the ON switch. Note If the system cannot be switched on, the EMERGENCY STOP button may have been actuated inadvertently, e.g. during a transport. Check whether the EMERGENCY STOP button is locked and unlock it if applicable. 7-3

62 7 Switching the System On 7.4 Key switch The monitor cart is equipped with a key switch. Depending on your chosen configuration, it is used for locking either the entire system (Power on) or only the radiation function (X-ray on/off) of the unit. This allows you to prevent unauthorized persons from switching on the unit or initiating radiation. Fig. 7-3 Key switch for locking the entire system (left) or the radiation function (right), Lock position Power on With the Power on key switch you can completely switch off the unit (equivalent to OFF switch) and lock it. When you remove the key while it is in the Lock position, the can no longer be switched on with the ON switch. To be able to switch on and operate the, you must first insert the key and turn it to the Unlock position. While in the Unlock position, the key cannot be removed. X-Ray on/off With the X-Ray on/off key switch, you can lock the radiation function of the unit. When you remove the key while it is in the Lock position, it is possible to switch on the and to use functions such as patient data management or image postprocessing. However, it is not possible to initiate radiation with the hand or foot switch. To be able to initiate radiation, you must first insert the key and turn it to the Unlock position. While in the Unlock position, the key cannot be removed. 7-4

63 Standard Fluoroscopic Operations Overview To perform a standard fluoroscopy, you must always make the following steps and settings: Steps and settings Create a new patient folder in the Patient operating mode, or activate the desired patient folder in the Patient or Archive operating mode. Select the desired fluoroscopy mode in the Fluoroscopy or Subtraction operating mode. If you have not activated a patient folder before, the system automatically creates and activates a patient folder. Select the fluoroscopy program. Generate the fluoroscopic image. Save the fluoroscopic image. Print out the fluoroscopic image, if desired. 8-1

64 8 Standard Fluoroscopic Operations 8.2 Fluoroscopy modes Fluoroscopy modes During fluoroscopy, radiation is interrupted at certain intervals (pulsed). The length (pulse width) and frequency (pulse rate) of the radiation interval are preset for each anatomical program and are displayed on the control panel. The provides two different pulsed fluoroscopy modes: Continuous pulse fluoroscopy ( Ch , p. 8-2) Digital radiography (snapshot) ( Ch , p. 8-4) Anatomical programs Both fluoroscopy modes work with automatic exposure rate control (AERC), unless manual exposure rate setting has been selected explicitly by the user ( Ch. 8.3, p. 8-5). The tube voltage and the tube current are adjusted automatically, taking into account the selected fluoroscopy program ( Ch. 8.4, p. 8-7) as well as the thickness and structure of the object. Automatic exposure rate control (AERC) reduces the radiation burden of both patient and operating staff to a minimum and prevents overexposure of the screened body region Continuous pulse fluoroscopy In continuous pulse fluoroscopy mode, the system emits radiation pulses as long as you press the radiation switch. Pulse rate You may adjust the pulse rate. The lower the pulse rate setting, the lower the radiation dose. Pulse width The pulse width is indicated in percent and cannot be modified. A pulse width of 100% corresponds to 40 ms (U.S.A.: 30 ms). Pulse settings for anatomical programs The pulse width and pulse rate for each anatomical program are preset in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Please contact your service engineer if you wish to set or modify the pulse width and/or pulse rate values for one or more anatomical programs. 8-2

65 8 Standard Fluoroscopic Operations To generate an image in the continuous pulse fluoroscopy mode, do the following: Press the Continuous Pulse Fluoroscopy button. The preset pulse width and pulse rate for the selected anatomical program are indicated on the Pulsewidth % and Pulses /s displays on the control panel. The pulse rate setting buttons are displayed in the dynamic control area. Fig. 8-2 Pulse rate setting (on systems with a nominal frequency of 60 Hz) Press the button for the desired pulse rate, e.g. 2 pulses / s. Initiate radiation. For each individual anatomical program, certain filter factors can be preset for the continuous pulse fluoroscopy mode. This is done in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Filter factors Please contact your service engineer if you wish to set or modify the filter factors for one or more anatomical programs. 8-3

66 8 Standard Fluoroscopic Operations Digital radiography (snapshot) In snapshot mode, the radiation time does not depend on how long you press the radiation switch. For each anatomical program, a specific AERC characteristic is stored on the system for the digital radiography mode. The fluoroscopy parameters are adjusted using the respective AERC characteristic, and radiation is terminated automatically afterwards. The pulse rate setting buttons are displayed in the dynamic control area. You cannot make any further settings with these buttons, though. Fields of application The snapshot mode is suitable for examinations involving no patient movement. The aim of snapshot mode is to generate high-quality static images, e.g. for printing / documentation purposes. To generate an image in the snapshot mode, do the following: Press the Snapshot button. Initiate radiation. To deactivate the snapshot mode, press the Continuous Pulse Fluoroscopy button. Note When you activate the snapshot mode, the Cine button disappears from the control panel. Filter factors For each individual anatomical program, certain filter factors can be preset for the snapshot mode. This is done in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Please contact your service engineer if you wish to set or modify the filter factors for one or more anatomical programs. 8-4

67 8 Standard Fluoroscopic Operations 8.3 Manual exposure rate setting The tube voltage and the tube current are usually adjusted automatically by the system s automatic exposure rate control. You may, however, set the exposure rate also manually, if necessary. WARNING To protect the health of patients and staff against high radiation doses, the manual dose rate setting mode remains blocked until you have initiated radiation in one of the fluoroscopy modes with automatic exposure rate control at least once. Only use the manual exposure rate setting mode in exceptional circumstances. The automatic exposure rate control provides optimum image quality while minimizing the dose rate. To generate an image in the manual exposure rate setting mode, do the following: Select the desired anatomical program ( Ch , p. 8-7). Select one of the fluoroscopy modes with automatic exposure rate control: Continuous pulse fluoroscopy or or Snapshot ( Ch. 8.2, p. 8-2). Initiate radiation for a brief moment. Press the Manual Exposure Rate Setting button. The kv value which has been automatically determined is saved for subsequent fluoroscopies, and the system switches to the manual mode. The setting buttons are displayed in the dynamic control area. 8-5

68 8 Standard Fluoroscopic Operations Fig. 8-3 Settings in the manual exposure rate setting mode Select the desired kv and ma values using the Up Arrow and Down Arrow buttons. Each time you press an arrow button, the value is increased/decreased by 1 kv or 0.1 ma. Initiate radiation. To deactivate the manual exposure rate setting mode, do the following: Press the Manual Exposure Rate Setting button. or or Press the Off button in the dynamic control area. The manual exposure rate setting mode is deactivated. 8-6

69 8 Standard Fluoroscopic Operations 8.4 Fluoroscopy programs Anatomical programs The following anatomical programs are available: Bones The Bones anatomical program is optimized for visualizing any part of the human skeleton. It is used mainly in orthopedics. Heart The Heart anatomical program is optimized for visualizing the heart and the thorax. It is used e.g. in heart surgery or also dilatations in the heart region. Abdomen The Abdomen anatomical program is optimized for visualizing any anatomical structure in the abdominal region. It is used e.g. in urology, for cholangiographies and for preparing dilatations and stent implantations. Soft The Soft anatomical program is optimized for visualizing soft tissues. It is used e.g. for foreign body localization and for visualization of syringe needles and skin contours. To activate an anatomical program, do the following: Press the button for the desired anatomical program. The button is highlighted in yellow. The anatomical program remains active until you choose another program. If required, a number of supplementary functions can be combined with any anatomical program: Metal artifact correction ( Ch , p. 8-8) Reposition ( Ch , p. 8-8) High Quality ( Ch , p. 8-8) Large Patient ( Ch , p. 8-9) For each of these anatomical programs, certain filter factors can be preset. This done in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Filter factors Please contact your service engineer if you wish to set or modify the filter factors. 8-7

70 8 Standard Fluoroscopic Operations Metal artifact correction function The metal artifact correction function corrects a possible flaring of the fluoroscopic image resulting from metal objects in the beam path and increases contrast at tube voltages above 50 kv. The metal artifact correction function can be combined with any anatomical program. To activate the metal artifact correction function, do the following: Press the Metal button. The button is highlighted in yellow. To deactivate the metal artifact correction function, do the following: Press the Metal button again. The button returns to its gray color, and the metal artifact correction function is deactivated Reposition function The reposition function uses special filter settings to reduce motion blurring in the fluoroscopic images. The reposition function can be combined with any anatomical program. To activate the reposition function, do the following: Press the Reposition button. The button is highlighted in yellow. To deactivate the reposition function, do the following: Press the Reposition button again. The button returns to its gray color, and the reposition function is deactivated High quality function The high quality function further enhances the image quality. The high quality function can be combined with any anatomical program. In the DSA and cine loop mode, the high quality function is automatically activated. If you activate the high quality function in another mode and initiate radiation, an audible alarm sounds. Keep the radiation time as short as possible, since the high quality function uses a higher radiation dose. 8-8

71 8 Standard Fluoroscopic Operations To activate the high quality function, do the following: Press the High Quality button. The button is highlighted in yellow. When you initiate radiation, an audible alarm sounds. To deactivate the high quality function, do the following: Press the Continuous Pulse Fluoroscopy button. The button returns to its gray color, and the high quality function is deactivated Large patient function The large patient function enables screening of patients of heavy built. The large patient function can be combined with any anatomical program. To activate the large patient function, do the following: Press the Large Patient button. The button is highlighted in yellow. To deactivate the large patient function, do the following: Press the Continuous Pulse Fluoroscopy button. The button returns to its gray color, and the large patient function is deactivated. 8.5 Screen display during radiation While radiation is active, the current fluoroscopic image is displayed on the live screen. When you terminate radiation (by releasing the hand or foot switch), the last fluoroscopic image is displayed on the live monitor (Last Image Hold). This image remains displayed until it is replaced by a new fluoroscopic image. Fluoroscopic image During the exposure, the tube voltage and the tube current are determined by the system, and the values are shown on the Voltage and Current displays of the control panel. Fluoroscopy parameters 8-9

72 8 Standard Fluoroscopic Operations Optical signals During the exposure (fluoroscopy or direct radiography), the yellow radiation warning lamp on the monitor cart and the X-ray symbol on the control panel are illuminated. ( Ch , p. 6-1). 8.6 Dose area product The dose area product is saved for each patient folder and updated with each exposure, so that you can always see the total dose received by a patient until now. This also includes the dose area product for images which have not been saved. Display on the control panel When you activate a patient folder and switch to the Fluoroscopy or Subtraction operating mode, the total dose received by the patient until now is shown in the Dose Area Product display. Image information on the monitor When you generate a new fluoroscopic image or open a saved image, the total dose area product for the active patient folder is displayed on the monitor ( Ch , p. 16-3). 8.7 Saving CAUTION When the hard disk is full, the oldest patient folder will be overwritten without warning. Before saving an image, make sure that there is enough free hard disk space, and regularly back up the patient folders which are still needed on external storage media or on a network. Image number Each saved image automatically receives an image number. These image numbers are assigned and incremented consecutively for each separate patient folder. Unsaved images (those without a number) will be replaced by a new fluoroscopic image during the next fluoroscopy. Default foot switch assignment Usually the save image function is assigned to the right pedal of the twopedal foot switch. Depending on the customer-specific configuration, the foot switch pedals may be programmed with other functions and are labeled accordingly in this case. 8-10

73 8 Standard Fluoroscopic Operations To save the last image displayed on the live monitor to the active patient folder, do the following: Press the Save button. or or If the right foot switch pedal is programmed with the save image function: Press the right pedal of the two-pedal foot switch. During the save operation, the save symbol is displayed on the live monitor. When the save operation has been completed, the image number is displayed on the monitor ( Ch , p. 16-1). 2 You can configure the so that during each fluoroscopy a new image will be saved automatically as soon as you terminate radiation (autostore). Autostore To activate the autostore function, do the following: Press the Save button for approx. 2 seconds. The autostore function is activated. The Save button is highlighted in yellow. During each subsequent fluoroscopy, a new image is automatically saved as soon as you terminate radiation. To deactivate the autostore function, do the following: Press the Save button briefly. The button returns to its gray color, and the autostore function is deactivated. Alternatively, you can activate and deactivate the autostore function in the Configuration operating mode under Operation Settings ( Ch , p. 20-3). When you attempt to save an image and there is not enough hard disk space left, the patient folders and/or images on the hard disk will be overwritten automatically and without confirmation prompt in the following order: Auto-delete function First, the oldest patient folder is overwritten. If there is still not enough disk space for the save operation, then the second oldest, third oldest, etc., patient folder are deleted. However, the active patient folder is never deleted. If a patient folder contains one or more protected images, only the unprotected images are deleted, but not the protected images or the folder itself. 8-11

74 8 Standard Fluoroscopic Operations If it is not possible to free up enough space on the hard disk for the save operation due to the large number of protected images, an audible alarm sounds and the following alert message appears on the control panel: Not enough space on hard disk. Required: xyz. Available: xyz. The save operation is aborted. Cine loop When you attempt to generate a cine loop, the system will check whether the remaining hard disk space is sufficient for the selected number of images ( Ch. 12.2, p. 12-1). If disk space is insufficient, the unprotected patient folders and/or images are deleted in the above order. If this does not free up sufficient disk space either, no cine loop is acquired. Note If more than 75% of the hard disk is full, the exact percentage of used hard disk space will be displayed on the screen during power-up of the system. This gives you an approximate idea of the remaining hard disk space. 8.8 Printing the live monitor image The print live monitor image function is available in the following operating modes: Fluoroscopy, Subtraction, Post Process, Measurement and Archive. This function is only enabled if the monitor cart is equipped with a video printer. The function always prints out the image which is displayed at full-screen size on the live monitor. The text information that is displayed on the screen together with the image (name of the patient, angle of rotation of the image, etc.) will appear as a text block on a gray background at the left margin of the printout. If you have performed measurements in an image and saved them subsequently, the measured values are printed on a second page. To print out the live monitor image on the video printer, do the following: Press the Print Live Monitor Image button. The image displayed on the live monitor is printed. 8-12

75 8 Standard Fluoroscopic Operations 8.9 Warning signals and faults Permanent warning during radiation Active radiation (both during fluoroscopy and direct radiography) is indicated by two optical signals: The yellow radiation warning lamp on the monitor cart is illuminated. The X-ray symbol on the control panel is illuminated Interval warning during radiation In order to prevent radiation from being accidentally generated over a long time, the system has a warning function. After each 5 minutes of elapsed total radiation time per patient, the system issues the following interval warning: Warning function After 4 min. 55 sec., the following message appears on the control panel: The radiation time is 5 minutes. Switch off alarm? 5 seconds later, an audible alarm sounds. CAUTION If you do not switch off the alarm after 30 seconds max., radiation will be terminated automatically. You can see the total radiation time for the active patient folder on the Radiation Time display. To switch off the alarm, do the following: In the message window The radiation time is 5 minutes. Switch off alarm? press the Yes button. The audible alarm is not started or stops (if it is already sounding). The total radiation time remains displayed. 8-13

76 8 Standard Fluoroscopic Operations Temperature monitoring The thermal conditions in the generator are indicated by the Temperature symbol. Active Cooling During power-up of the system, the cooling pump is switched on automatically. This function significantly prolongs the time until the generator reaches its shutdown temperature Error and alert messages In the event of faults, the corresponding error and alert messages are displayed as text in a message window on the control panel. Error and alert messages always start with the letter E. At the same time, an audible alarm sounds. For a detailed explanation of the messages, please refer to Appendix A.3.2, p. A-8. In case of faults, please communicate the fault code number and the serial number of the system to your after-sales service center. To close a message window which displays an error or alert message, press the Yes button. 8-14

77 Adjusting Live Images Overview The offers the following functions for adjusting the appearance of the live image to your individual needs: Contrast/Brightness: Monitor settings Individual adjustment Contrast/Brightness: Contrast and brightness adjustment of individual images (windowing) Filter: Recursive filter, stack filter and edge filter Magnify: Electronic image magnification Zoom: To enlarge a selected image detail Grayscale Inversion: To display an image with negative grayscale Iris Collimator Vertical Slot Collimator Image Swapping: To move an image to the other monitor 9-1

78 9 Adjusting Live Images Reverse Up/Down: Vertical image reversal Reverse Left/Right: Horizontal image reversal Image Rotation Text: Text functions ( Ch. 16, p. 16-1) Any adjustments (except texts) which are applied to a live image on the live monitor remain valid for all subsequent live images until you choose other settings.when you save an image, it will be saved with all rotations, reversals, filter settings, texts and markers, etc. All these modifications (except texts) are visible when the image is displayed as a thumbnail in the mosaic. 9.2 Contrast and brightness settings for the CRT monitors Function You can adjust the contrast and brightness of both monitors. These settings affect any image or thumbnail image mosaic displayed on the monitors and remain in force until you make new monitor settings or restart the system. Initial settings You can preset the initial monitor settings which are valid after power-up of the system for both monitors in the Configuration operating mode under Monitor / Dose ( Ch. 20.4, p ). 9-2

79 9 Adjusting Live Images Fig. 9-1 Monitor settings and step windowing To adjust the contrast and brightness of both monitors, do the following: Press the Contrast/Brightness button. The monitor setting buttons are displayed in the dynamic control area. Fig. 9-2 Monitor setting and step windowing buttons Use the arrow buttons to set the desired brightness and contrast. The new settings are reflected immediately on both monitors. If you want to restore the initial settings, press the Home button. Contrast and brightness are reset to the initial settings. Step windowing is reset to step 0. Press the Contrast/Brightness button. The monitor setting buttons disappear from the dynamic control area. 9-3

80 9 Adjusting Live Images Ambient light sensor The is equipped with an ambient light sensor. The sensor works automatically, so you do not need to activate it explicitly. The screen brightness is continuously readjusted to match any change in ambient light conditions during operation. The readjustment procedure is quite slow (up to 1 minute in duration) in order to suppress monitor flickering. Proper functioning of the ambient light sensor can be checked in the Configuration operating mode ( Ch. 20.4, p ). 9.3 Contrast and brightness adjustment of individual images (windowing) Function The Windowing function allows you to adjust the contrast and brightness of the image on the live monitor. These settings affect any newlyacquired live image which is displayed on the live monitor and remain in force until you make new windowing settings. When you save the live image, the corresponding windowing values are saved together with the image. After activating the windowing function, you can select a number of gray levels, which are then stretched over the entire range of 1024 gray levels of the original image on the live monitor. To achieve this effect, you adjust the width and the level of the so-called contrast window. The number of gray levels defines the width of the contrast window. The width of the contrast window affects the image contrast gray levels correspond to the value W 100 on the. The position of the selected gray levels on the original image grayscale (ranging from 0 to 1024 gray levels) defines the level of the contrast window. The level of the contrast window affects the image brightness. Example: You select all gray levels between 325 and 875. These gray levels are then mapped (stretched) to the range of 0 to 1024 gray levels in the processed image. This enhances the contrast. Gray levels 0 to 324 of the original image are displayed as black, and gray levels 876 to 1024 of the original image are displayed as white. This means that the processed image is darker than the original image. There are two different windowing modes available: Standard windowing: The standard windowing mode allows you to freely choose the level and width of the contrast window. Step windowing: With step windowing, you choose between several predefined windowing steps. These steps are preset and cannot be modified. 9-4

81 9 Adjusting Live Images The chosen windowing values are shown on the monitor as W X for the width and L X for the level. Note When you change the windowing values of a single cine loop image, the change will apply to all images of the respective cine loop. To set the brightness and contrast in standard windowing mode, do the following: Press the Contrast/Brightness button. The monitor setting buttons are displayed in the dynamic control area. Fig. 9-3 Monitor setting and step windowing buttons Press the WNDW button. The windowing setting buttons appear. Fig. 9-4 Buttons for standard windowing Under Width, set the number of gray levels using the arrow buttons. The chosen width is indicated by the length of the blue bar in the dynamic control area. The changes are reflected immediately in the image on the live monitor. Under Level, set the brightness range using the arrow buttons. The chosen level is indicated by the position of the slider in the dynamic control area. The changes are reflected immediately in the image on the live monitor. If you want to restore the factory settings (level 50, width 100), press the Home button. 9-5

82 9 Adjusting Live Images To set the brightness and contrast with step windowing, do the following: Press the Contrast/Brightness button. The monitor setting buttons are displayed in the dynamic control area. Fig. 9-5 Monitor setting and step windowing buttons Select the desired windowing step using the arrow buttons. The settings are reflected immediately in the image on the live monitor. If you want to restore the factory settings for step windowing, press the Home button. Step windowing is reset to step 0. Simultaneously, brightness and contrast are reset to the initial settings. Press the Contrast/Brightness button. The monitor setting buttons disappear from the dynamic control area. 9-6

83 9 Adjusting Live Images 9.4 Filters You may apply different filters to the live image. The following filters are available: Recursive filter Edge filter Stack filter (LIH) Fig. 9-6 Filter settings in the live image Recursive filter The recursive filter adds the specified number of images during fluoroscopy. Each newly-acquired image is superimposed by the result of the previous addition with a certain weighting factor. The higher the number of images you select, the greater the noise suppression, but also the greater motion blurring. Noise suppression There are three recursive filter levels, each corresponding to a preset number of images between 1 and 16. To set the recursive filter for the live image, do the following: Press the Filter button. The filter setting buttons are displayed in the dynamic control area. 9-7

84 9 Adjusting Live Images Fig. 9-7 Filter settings for recursive, edge and stack filter Under Recursive, select the desired recursive filter level by pressing the corresponding button. The filter acts on the live image on the live monitor. The chosen recursive filter level is shown on the monitor as NR X. Press the Filter button. The filter setting buttons disappear from the dynamic control area. Configuration The specific settings for the individual recursive filter levels are made in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Please contact your service engineer if you wish to set the individual recursive filter levels or modify the present settings Edge filter Edge enhancement The edge filter allows you to select a greater or lesser degree of edge enhancement within the image. There are 4 levels available: Level Meaning Off No edge enhancement (original fluoroscopic image) 1 Slight edge enhancement 2 Medium edge enhancement 3 Strong edge enhancement -1 Unsharp mask to reduce noise Table 9-1 Edge filter levels 9-8

85 9 Adjusting Live Images To set the edge filter for the live image, do the following: Press the Filter button. The filter setting buttons are displayed in the dynamic control area. Fig. 9-8 Filter settings Under Edge, select the desired edge filter level by pressing the corresponding button. The filter acts on the live image on the live monitor. The chosen edge filter level is shown on the monitor as RTE Y. Press the Filter button. The filter setting buttons disappear from the dynamic control area Stack filter The stack filter generates and adds a specified number of images after radiation has been terminated. The higher the number of images you select, the greater the noise suppression, but also the greater motion blurring if the patient moves during image generation. You can choose between the following number of images: 1 image (Off), 2, 4, 8, 16 images. Noise suppression To set the stack filter for the live image, do the following: Press the Filter button. The filter setting buttons are displayed in the dynamic control area. Fig. 9-9 Filter settings Under LIH, select the desired stack filter level by pressing the corresponding button. 9-9

86 9 Adjusting Live Images The filter acts on the live image on the live monitor. The chosen stack filter level is shown on the monitor as LIH Z. Press the Filter button. The filter setting buttons disappear from the dynamic control area. 9.5 Electronic image magnification Function The image intensifier s format selection function ( magnification ) magnifies the fluoroscopic image electronically, whereby the image resolution increases proportionally to the magnification factor. This function is not available on a FD. For 23 cm i.i. systems, the magnification levels 23 cm, 15 cm and 10 cm are available. For 31 cm i.i. systems, the magnification levels 31 cm, 23 cm and 15 cm are available. The current image magnification level is automatically indicated on the Magnify button. To select the image magnification level, do the following: Press the Magnify button. The current level is indicated on the button. The magnification level setting buttons are displayed in the dynamic control area. Fig Image magnification levels Select the desired image magnification level. The settings become immediately valid on the live monitor. The chosen image magnification level is shown on the monitor as MAG X. Press the Magnify button. The magnification level setting buttons disappear from the dynamic control area. 9-10

87 9 Adjusting Live Images 9.6 Digital image zooming The zoom function allows you to enlarge a certain image detail. There are three zoom levels available. The desired image detail can be controlled either with the arrow buttons or with the integrated touchpad. Function Touchpad Fig Zoom function for the live image To enlarge an image detail, do the following: Press the Zoom button. The active image also appears on the reference monitor. The zoom function buttons are displayed in the dynamic control area. Fig Zoom function settings Select the desired zoom factor by pressing the corresponding button, e.g. 4 X. A marking circle appears in the center of the live image on the live monitor. The image area within the marking circle is displayed on the reference monitor with the chosen zoom level. Move the marking circle to the desired image area using the arrow buttons. The chosen image detail is displayed on the reference monitor with the chosen zoom level. 9-11

88 9 Adjusting Live Images If you want to move the marking circle back to the center of the live image, press the Home button. Press the Zoom button. The zoom function buttons disappear from the dynamic control area. To enlarge an image detail with the help of the touchpad, do the following: Press the Zoom button. The active image also appears on the reference monitor. The zoom function buttons are displayed in the dynamic control area. Fig Zoom function settings Select the desired zoom factor by pressing the corresponding button, e.g. 4 X. A marking circle appears in the center of the live image on the live monitor. The image area within the marking circle is displayed on the reference monitor with the chosen zoom level. Move the marking circle to the desired position by gliding your finger slightly across the touchpad. The chosen image detail is displayed on the reference monitor with the chosen zoom level. If you want to move the marking circle back to the center of the live image, press the Home button. Press the Zoom button. The zoom function buttons disappear from the dynamic control area. 9-12

89 9 Adjusting Live Images 9.7 Grayscale inversion The grayscale inversion function allows you to represent the live image with a negative grayscale. Function To represent an image with a negative (or positive) grayscale, do the following: Press the Grayscale Inversion button. The live image is represented with a negative grayscale on the live monitor, and the button is highlighted in yellow. Press the Grayscale Inversion button again. The live image is again represented with a positive grayscale, and the button returns to its gray color. 9.8 Collimation The system is equipped with an iris and a slot collimator. These collimators allow you to limit the area of exposure of the patient just to the region of interest. Function This offers the following advantages: Reduction of the radiation burden Less chance of flaring Better detail rendition and higher contrast Iris collimator The iris collimator can be adjusted steplessly. Normally, the iris collimator is completely open, and only the Close Iris Collimator button is visible on the control panel. As soon as you start closing the iris collimator, the Open Iris Collimator button appears on the control panel. To adjust the iris collimator, do the following: Press the Close Iris Collimator button until the collimator aperture on the live monitor is as desired. The Open Iris Collimator button appears on the control panel. Press the Open Iris Collimator button until the collimator aperture on the live monitor is as desired. 9-13

90 9 Adjusting Live Images In addition, you can fully open the iris collimator in one step: Press the Open Iris Collimator Fully button Slot collimator The slot collimator can be adjusted steplessly. Normally, the slot collimator is completely open, and only the Close Vertical Slot Collimator button is visible on the control panel. As soon as you start closing the slot collimator, the Open Vertical Slot Collimator, Rotate Vertical Slot Collimator CW and Rotate Vertical Slot Collimator CCW buttons appear on the control panel. To adjust the slot collimator, do the following: Press the Close Vertical Slot Collimator button until the collimator aperture on the live monitor is as desired. The Open Vertical Slot Collimator, Rotate Vertical Slot Collimator CW and Rotate Vertical Slot Collimator CCW buttons appear on the control panel. Press the Open Vertical Slot Collimator button until the collimator aperture on the live monitor is as desired. Press the Rotate Vertical Slot Collimator CW button until the collimator orientation on the live monitor is as desired. Press the Rotate Vertical Slot Collimator CCW button until the collimator orientation on the live monitor is as desired. In addition, you can fully open the slot collimator or reset it to the 0 position, each in one step: Press the Open Vertical Slot Collimator Fully button. The slot collimator opens completely. Press the Rotate Vertical Slot Collimator to 0 button. The slot collimator is reset to the 0 position. 9-14

91 9 Adjusting Live Images Virtual collimator The is equipped with a virtual collimator, allowing you to adjust the collimators without radiation. Using this feature, you can significantly reduce patient exposure. Function To perform a virtual collimation, do the following: Press the Open Iris Collimator Fully button. The iris collimator opens completely. Press the Open Vertical Slot Collimator Fully button. The vertical slot collimator opens completely. Select the desired anatomical program ( Ch , p. 8-7). Initiate radiation for a brief moment. The generated image is displayed on the live monitor. Adjust the iris and the slot collimator as desired without radiation. The areas of the image that will not be visible later are shown beneath a gray overlay. The collimator boundaries are represented by white edges. Initiate radiation. 9.9 Image swapping With the image swapping function, you can move an image from one monitor to the other. This allows you to generate two images and to compare them directly to one another. Function To compare an image with a live image, do the following: Generate a live image. The image is displayed on the live monitor. Press the Image Swapping button. The first image is moved to the reference monitor. 9-15

92 9 Adjusting Live Images Generate a second live image. The image is displayed on the live monitor. Now you can compare the images on the two monitors to one another Image reversal and image rotation Function The image reversal and image rotation functions are used for individual adjustment of the image orientation on the live monitor. You can use these functions to align the image orientation with the patient s orientation. To make orientation easier for the operator, a label is attached to both the image intensifier and the generator housing, showing a patient in supine position. If the patient is positioned as illustrated by the label, then the image orientation on the live monitor corresponds to the patient s orientation. Both image reversal and image rotation are produced digitally and without the need to initiate any further radiation Horizontal and vertical image reversal Press the reverse up/down button. The button is highlighted in yellow. On the live monitor, the image appears with top and bottom reversed, and a symbol for up/down reversal is displayed. Press the Reverse Left/Right button. The button is highlighted in yellow. On the live monitor, the image appears with left and right side reversed, and a symbol for left/right reversal is displayed. Image reversal is symbolized on the monitor by an R which is either mirrored left-right or upside-down. 9-16

93 9 Adjusting Live Images Image rotation Press the Rotate Image CW button until the image orientation on the live monitor is as desired. The image is rotated steplessly in clockwise direction. Press the Rotate Image CCW button until the image orientation on the live monitor is as desired. The image is rotated steplessly in counter-clockwise direction. The chosen angle of rotation is shown on the monitor as RX. As soon as an image is rotated, it assumes a circular shape. The image has a square shape only in the following angle positions: 0 /360, 90, 180, 270. FD To reset the angle of rotation to 0, do the following: Press the Rotate Image to 0 button. The image is reset to the 0 position. 9-17

94 9 Adjusting Live Images 9-18

95 Data Management Organization of patient and image data Patient and image data is managed in the Patient ( Ch. 10.2, p. 10-2) and Archive operating modes ( Ch. 10.3, p. 10-7). All data of a patient is stored in a patient folder on the hard disk. All image data is assigned to the corresponding patient folder. When you switch to the Fluoroscopy or Subtraction operating mode and no patient folder is active, the system will automatically create a new patient folder ( Ch , p. 10-2) Patient folders In order to be able to relate the fluoroscopic images to a certain patient, you must always create or activate a patient folder before acquiring an image or a cine loop. Function You can create as many patient folders as desired on the hard disk. In each patient folder, you can store as many images as you wish. The total number of images is limited only by the hard disk size ( image memory ). The size of the image memory depends on the chosen system configuration. Storage capacity When you save an image for which there would be no more space on the hard disk otherwise, the oldest patient folder on the hard disk is automatically overwritten ( Ch. 8.7, p. 8-10). If the oldest patient folder contains one or more protected images ( p ), only the unprotected images are deleted, though. The folder itself as well as the protected images are preserved. Auto-delete function 10-1

96 10 Data Management Generated patient folders When you switch on the system, a new patient folder is automatically generated and activated. If you do not activate another patient folder before switching to the Fluoroscopy or Subtraction operating mode, all images are saved to this automatically generated patient folder. Generated data The patient name which is generated is composed of the time of day and date, e.g. P_12_34_01_04_03 for a patient folder which was created on April 1, 2003 at 12:34 o clock. In addition, a patient ID called PAT xyz is entered. If you have predefined default data for the Hospital, Department and Doctor input boxes, this data is also written to the generated patient folder. All images and/or cine loops will be saved to the generated patient folder until you activate another patient folder. You may edit or complete all patient data later ( Ch , p. 10-5). If the system has generated such a patient folder, but no images or cine loops have been saved to it, the generated patient folder will be deleted during the next power-up of the Managing patient data Patient data is managed in the Patient operating mode. When you create a new patient folder, you may retrieve the patient s data from a DICOM server under certain conditions ( Ch. 11.2, p. 11-1). Length of the patient ID The length of the patient ID is limited by the system to 64 digits. Display of the patient ID If the patient number cannot be displayed completely in the fluoroscopic image, it is represented in the form In the read-only boxes in the Archive operating mode, only the first 18 or 24 digits of the patient ID are displayed. In the Patient ID input box in the Patient operating mode, you can scroll through the whole patient ID using the arrow keys of the keypad. Access. No. You can manually enter a hospital-specific internal administrative number (Access. No.), or scan / import it with the patient data. Subject You can enter a subject for each patient folder, which is saved together with the patient data. Editing data You can edit all data in an existing patient folder or add new data at any time. 10-2

97 10 Data Management When you have created a new patient folder or activated an existing patient folder, you can import one or more images or a series of images from a DICOM server into this patient folder ( Ch. 11.5, p ). Importing images from a DICOM server Note The date formats may vary, depending on the customer-specific settings. In this manual, all date formats appear in the format DD.MM.YYYY. To activate the Patient operating mode, do the following: Press the Patient tab. The input boxes of the Patient operating mode as well as the alphanumeric keypad are now available on the control panel. Buttons for the input boxes Input boxes Alphanumeric keypad Fig Patient operating mode When you have activated a patient folder, the corresponding data is displayed in the input boxes Creating a new patient folder on the When you create a new patient folder, you may choose between the following ways of entering the patient data: You enter the patient data manually using the alphanumeric keypad. You retrieve the patient data from the DICOM server (Query or Worklist, Ch. 11.2, p. 11-1). 10-3

98 10 Data Management Entering patient data manually Press the Patient tab. The Patient operating mode is activated. Note You may predefine default data for the Hospital, Department and Doctor input boxes. The desired data is entered in the Configuration operating mode under Basic Settings. Press the New button. The input boxes are cleared (if any data has been displayed before in them), with the exception of those with default data ( Ch , p ). You may now enter the patient data. Press the button of the desired input box, e.g. the Last Name button. The button is highlighted in yellow. The cursor jumps to the corresponding input box. Note To type an uppercase letter, press and release the Shift key before entering the respective letter. The Shift key is valid for one subsequent letter. If you want to type several consecutive uppercase letters, press the Caps Lock key before entering the letters. or Enter the patient data with the help of the alphanumeric keypad. To move to the next input box, always press the Enter key. You must fill in at least the Last Name input box. The length of the patient number must not exceed 64 digits. If you do not enter any patient ID, the system automatically assigns a number in the Patient ID box. Save the new patient folder and the data entered by pressing the Save button. The new patient folder is automatically activated. A blank fluoroscopy mask with the newly-entered patient data appears on the live monitor. You may now proceed to generating fluoroscopic images, which will be assigned to the newly-created patient folder automatically: Switch to the Fluoroscopy or Subtraction operating mode and generate the desired fluoroscopic images ( Ch. 8, p. 8-1). 10-4

99 10 Data Management Modifying patient data You can modify the patient data in any existing patient folder at any time. You can use the name of the patient, the patient ID or a subject to search for the patient folder whose data you want to modify. Any patient data changes affect all existing and future images as well as the active image. Effects CAUTION If you use the patient ID to search for a patient folder, please verify the search result by checking the patient name. It may happen occasionally that a patient ID is assigned more than once on a DICOM network. To modify the data in an existing patient folder, do the following: Press the Patient tab. The Patient operating mode is activated. Fig Patient operating mode The input boxes may contain data you want to delete. Press the New button. The data in all input boxes is deleted. Press the Search button. A thumbnail mosaic with all patient folders is displayed on the reference monitor. Each patient folder is symbolized by the most recent image contained in it. 10-5

100 10 Data Management In the dynamic control area, the input boxes for searching as well as an alphabetically sorted list of all patient folders are displayed. Fig Input boxes for searching and hit list Now you can browse through the patient folder mosaic with the help of the arrow buttons or enter the desired search string: Press the button of the desired input box, e.g. the Last Name button. The button is highlighted in yellow. The cursor jumps to the corresponding input box. Enter the search string using the alphanumeric keypad. Note The search function is not case-sensitive. With each letter you enter, the alphabetical hit list is more and more confined to match the search string. The All button appears, allowing you to re-display the entire list. Select the desired item on the list using the arrow buttons and press the OK button. The data of the selected patient is transferred to the input boxes. You may overwrite this data now. Press the button of the input box whose data you want to modify. The button is highlighted in yellow. The cursor jumps to the corresponding input box. Overwrite the data you want to modify. Press the Save button. 10-6

101 10 Data Management A message window with a confirmation prompt is displayed: Press the Overwrite button. The existing data in the patient folder is overwritten by the newlyentered ones. or or Press the New button. A new patient folder with the modified data is created Image data management Image data is managed in the Archive operating mode. To activate the Archive operating mode, do the following: Press the Archive tab. The read-only boxes and buttons for managing the patient folders appear on the control panel. Hard Disk display List Readonly boxes Arrow buttons Fig Archive operating mode with USB storage device (option) 10-7

102 10 Data Management Mosaic All patient folders on the hard disk are displayed as a thumbnail mosaic (up to 16 images at a time) on the reference monitor, each folder being represented by its most recent image. In addition, the following information appears for each patient folder of the mosaic: name of the patient and number of images contained in the folder. You can browse through the thumbnail mosaic using the arrow buttons. List of patient folders The list shows the names of all patient folders in the order in which they were created. The most recent folder appears at the bottom of the list, the oldest one at the top. The name of the folder which is marked by the cursor on the reference monitor is highlighted by a yellow bar in the list, and the related data is displayed in the read-only boxes. You cannot enter or edit any data in these read-only boxes. Arrow buttons Using the arrow buttons you can move the cursor around the list and simultaneously from one patient folder or image to another on the reference monitor. Hard Disk display The Hard Disk display indicates the percentage of used hard disk space Processing patient folders The following functions for navigation and patient folder processing are available in the Archive operating mode: Search: To search for a patient folder ( Ch , p ) Pos 1: To place the cursor on the first patient folder in the mosaic End: To place the cursor on the last patient folder in the mosaic Mark: To mark one or more patient folders Delete: To delete patient folders 10-8

103 10 Data Management Invert entire archive: To invert the grayscale of all images on the hard disk Print: To print marked patient folders on the video printer CD/DVD: To write marked patient folders to CD or DVD USB: To save marked patient folders to a USB storage device DICOM Store: To save marked patient folders to a DICOM server ( Ch. 11.3, p. 11-8) Backup: To select patient folders and back them up to a USB storage device or a CD/DVD ( Ch , p ) Restore CD/DVD: To retrieve backed-up patient folders from a CD or DVD ( p ) Restore USB: To retrieve backed-up patient folders from a USB storage device ( p ) Depending on the chosen configuration, your may be equipped with a CD writer or alternatively with a DVD writer. With a CD writer, data can be written to or retrieved from CDs only. With a DVD writer, data can be written to or retrieved from both CDs and DVDs. CD writer or DVD writer Images in the following graphics formats have a file size of approx. 2 MB: 8 bit BMP 16 bit TIF DICOM Multimedia Image file sizes 10-9

104 10 Data Management Besides that, you may also save the images with reduced resolution and color depth in the following formats: DICOM Bit JPEG Images with reduced resolution and color depth have a file size of approx. 256 KB (1/4 MB). Note It is not possible to save a patient folder to a floppy disk. Marking All processing functions affect exclusively the marked patient folders. The only exception is the delete function: In this case it is possible to delete either all marked patient folders, or all unmarked patient folders, or only the patient folder where the cursor is. As soon as the marked patient folders have been output on a printer or saved to a storage medium, they will automatically become unmarked. To mark one or more patient folders, do the following: Select the desired patient folder in the thumbnail mosaic on the reference monitor using the arrow buttons. Press the Mark button. The patient folder is now marked and receives the label M. If you want to mark further patient folders in addition, repeat the procedure. To unmark a patient folder, do the following: Select the desired marked patient folder on the reference monitor using the arrow buttons. Press the Mark button. The patient folder becomes unmarked

105 10 Data Management You can delete a patient folder only if does not contain any protected images. When you try to delete a folder which contains protected images, the folder itself as well as the protected images remain on the hard disk. Only the unprotected images are deleted. If you want to delete protected images, you must unprotect them first ( p ). Deleting patient folders To delete one or more patient folders, do the following: Deleting CAUTION A deleted patient folder is irretrievably lost. Back up the patient folders you want to delete, or make sure that they are really no longer needed. Mark the patient folders you want to delete and press the Delete Marked Items button. The following confirmation prompt is displayed: or or Mark the patient folders you do not want to delete and press the Delete Unmarked Items button. The following confirmation prompt is displayed: or or Use the arrow buttons to select an individual patient folder you want to delete and press the Delete button

106 10 Data Management The following confirmation prompt is displayed: Confirm by pressing the Yes button. The patient folders are deleted from the hard disk. If one of the selected patient folders contains any protected images, only the unprotected images will be deleted, and the following message appears on the control panel: Patient folder with protected images cannot be deleted! Inverting the entire archive If you are used to working with negative images (e.g. because you are a radiologist), you can invert the grayscale of all images on the hard disk in one step. This function is not available for cine loops, DSA cine loops, MSA and RSA images. Images that have already been saved with a negative grayscale remain as they are. To invert all images or to undo the grayscale inversion, do the following: Press the Invert All button. The grayscale of all images on the hard disk is inverted. In mosaic view, the images are always represented with a positive grayscale. The negative grayscale will not become visible until you display an image at full-screen size. Terminate the Archive operating mode, or press the Invert All button again. The grayscale inversion of all images is undone. Printing on video printer You can mark one or more patient folders and print all images contained in them in one go. Besides, you can print the image displayed on the live monitor ( Ch. 8.8, p. 8-12). To print all images of one or several patient folders on the video printer, do the following: Mark the desired patient folders

107 10 Data Management Press the Print button. All images of the marked folders are output on the video printer mounted in the monitor cart. A progress indicator in a message window on the control panel informs you about the status of the print operation. The Cancel button appears, enabling you to interrupt the print operation. Once they have been printed, the patient folders become unmarked. To print out the live monitor image on the video printer, do the following: Press the Print Live Monitor Image button. The image displayed on the live monitor is printed. The images of one or more patient folders can be saved to a standard USB storage device in the following formats: TIF with 16 bit color depth JPEG with a resolution of pixels and 8 bit color depth DICOM DICOM with a resolution of pixels and 8 bit color depth The storage format is defined in the Configuration operating mode under Storage Media ( Ch , p ). Saving to USB storage device Whenever you save images in standard DICOM format or reduced DICOM format (with a resolution of pixels and 8 bit color depth) to a USB storage device, the Ziehm DICOM Viewer program is automatically saved to the USB storage device as well. This program enables you to view the DICOM images on any PC with Microsoft Windows operating system (version Microsoft Windows 98 or higher). Ziehm DICOM Viewer To save one or more patient folders to a USB storage device, do the following: Mark the desired patient folders. Plug the USB storage device into the USB port on the monitor cart. Press the USB button. The marked patient folders are saved to the USB storage device. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Once they have been saved, the patient folders become unmarked

108 10 Data Management Writing to CD or DVD The images of one or more patient folders can be written to CD or DVD in the following formats: TIF with 16 bit color depth JPEG with a resolution of pixels and 8 bit color depth DICOM DICOM with a resolution of pixels and 8 bit color depth Multimedia (Video CD or MPEG2) The storage format is defined in the Configuration operating mode under Storage Media ( Ch , p ). Ziehm DICOM Viewer Whenever you write images in standard DICOM format or reduced DICOM format (with a resolution of pixels and 8 bit color depth) to a CD/DVD, the Ziehm DICOM Viewer program is automatically written to the CD/DVD as well. This program enables you to view the DICOM images on any PC with Microsoft Windows operating system (version Microsoft Windows 98 or higher). To write one or more patient folders to CD or DVD, do the following: Mark the desired patient folders. Insert a CD or DVD into the CD or DVD writer mounted in the monitor cart. Press the CD/DVD button. The following messages appear one after the other: Checking CD/DVD... Write images to CD/DVD? Confirm by pressing the Yes button. A progress indicator in a message window on the control panel informs you about the status of the write operation. Once the write operation has been completed successfully, the following message is displayed: Writing of CD/DVD completed successfully Press the OK button. Once they have been written to CD or DVD, the patient folders become unmarked

109 10 Data Management Finding and displaying a patient folder The following criteria can be used to search for a patient folder: Name of the patient (Last Name box) Patient number (Patient ID box) Keyword (Subject box) You can combine these search criteria using an AND operation. Thus, you could look e.g. for all patients called Miller with the subject Knee. Search criteria CAUTION If you use the patient ID to search for a patient folder, please verify the search result by checking the patient name. It may happen occasionally that a patient ID is assigned more than once on a DICOM network. To find a patient folder, do the following: Press the Archive tab. The Archive operating mode is activated. Press the Search button. The input boxes for searching are displayed in the dynamic control area. A list of all patient names is displayed. Fig Input boxes for searching and hit list Now you can enter the desired search string(s). Press the button of the desired input box, e.g. the Last Name button. The button is highlighted in yellow. The cursor jumps to the corresponding input box. Enter the search string using the alphanumeric keypad. Note The search function is not case-sensitive

110 10 Data Management With each letter you enter, the alphabetical hit list is more and more confined to match the search string. The All button appears, allowing you to re-display the entire list. Press the Back button. You are returned to the Archive screen. The data of all patients who match the search string(s) is displayed in the list. The All button appears, allowing you to re-display the entire list. Select the desired patient folder using the arrow buttons. Press the OK button. All images contained in this patient folder are displayed as thumbnails on the reference monitor. The most recent image is highlighted by a white frame. Cine loop sequences are symbolized by their last image and bear the label C. Other buttons and read-only boxes for processing individual images ( Ch , p ) or cine loops ( Ch. 12.5, p. 12-8) appear on the control panel. Thumbnail display The thumbnails in the mosaic reflect all the modifications applied to them after fluoroscopy (e.g. contrast adjustment, rotation, zoom). Image information The information pertaining to the image which is marked by the cursor on the reference monitor is displayed on the control panel: Fig Archive operating mode: Read-only boxes displaying image information 10-16

111 10 Data Management Activating a patient folder To be able to save new images to an existing patient folder, you must activate this patient folder before switching to the Fluoroscopy or Subtraction operating mode. You can activate an existing patient folder either in the Patient or Archive operating mode. To activate a patient folder in the Patient operating mode, do the following: Press the Patient tab. The Patient operating mode is activated. Fig Patient operating mode The input boxes may contain data you want to delete. Press the New button. The data in all input boxes is deleted. Press the Search button. A thumbnail mosaic with all patient folders is displayed on the reference monitor. Each patient folder is symbolized by the most recent image contained in it. In the dynamic control area, the input boxes for searching as well as an alphabetically sorted list of all patient folders are displayed

112 10 Data Management Fig Input boxes for searching and hit list Now you can browse through the patient folder mosaic with the help of the arrow buttons or enter the desired search string: Press the button of the desired input box, e.g. the Last Name button. The button is highlighted in yellow. The cursor jumps to the corresponding input box. Enter the search string using the alphanumeric keypad. Note The search function is not case-sensitive. With each letter you enter, the alphabetical hit list is more and more confined to match the search string. The All button appears, allowing you to re-display the entire list. Select the desired item on the list using the arrow buttons. Press the OK button. The data of the selected patient is transferred to the input boxes, and the patient folder is activated. Now you can switch to the Fluoroscopy or Subtraction operating mode. To activate a patient folder in the Archive operating mode, do the following: Press the Archive tab. The Archive operating mode is activated. Press the Search button. The input boxes for searching are displayed in the dynamic control area. A list of all patient names is displayed

113 10 Data Management Fig Input boxes for searching and hit list Now you can enter the desired search string(s). Press the button of the desired input box, e.g. the Last Name button. The button is highlighted in yellow. The cursor jumps to the corresponding input box. Enter the search string using the alphanumeric keypad. Note The search function is not case-sensitive. With each letter you enter, the alphabetical hit list is more and more confined to match the search string. The All button appears, allowing you to re-display the entire list. Press the Back button. You are returned to the Archive screen. The data of all patients who match the search string(s) is displayed in the list. The All button appears, allowing you to re-display the entire list. Select the desired patient folder using the arrow buttons. Press the OK button. The patient data and the buttons for image and cine loop processing appear in the dynamic control area. Press the OK button. The patient folder is activated now. Now you can switch to the Fluoroscopy or Subtraction operating mode

114 10 Data Management Browsing through the active patient folder In the Fluoroscopy, Subtraction and Post Process operating modes, you can display all images of the active patient folder at full-screen size without having to switch to the Archive operating mode. Activate the desired patient folder ( Ch , p ). Switch to the desired operating mode (Fluoroscopy, Subtraction or Post Process). Use the arrow buttons to browse through the active patient folder. The Down Arrow button moves you to the image with the next lower image number. The Up Arrow button moves you to the image with the next higher image number Processing and outputting images in a patient folder Once you have displayed ( Ch , p ) or activated ( Ch , p ) a patient folder, you can process and output the images and the cine loops that are stored there. Different read-only boxes and buttons are displayed on the control panel for that purpose. Readonly boxes Buttons for marking and deleting Arrow buttons for navigating on the monitor Buttons for printing Buttons for saving Fig Archive operating mode with displayed patient folder 10-20

115 10 Data Management The read-only boxes show patient data and image information. The Images (Total) box shows how many images or cine loops are stored in the patient folder. If the cursor is on a cine loop within the patient folder, the Images box shows the number of images that make up the cine loop. If the cursor is on an individual image, the number 1 appears there. Read-only boxes We will now discuss how to process and output individual images. For information on how to process and output cine loops in a patient folder, please refer to Ch. 12.5, p The following functions are available in a displayed or active patient folder for navigating within the folder and for displaying and processing individual images: OK (with displayed patient folder only): To display an image at full-screen size on the live monitor and to activate the displayed patient folder Image processing and output Full-Screen Image: To display an image at full-screen size on the reference monitor Mosaic: To reset the live monitor to the mosaic view The Mosaic button appears as soon as you have chosen the fullscreen view on the live monitor. Pos 1: To place the cursor on the first image of the patient folder End: To place the cursor on the last image of the patient folder Mark: To mark one or more images Protect: To protect marked images against being deleted Delete: To delete images 10-21

116 10 Data Management DICOM Retrieve: To import images from a DICOM server into the displayed or active patient folder ( Ch. 11.5, p ) Print: To print marked images on the video printer DICOM Print: To print out marked images on a DICOM network printer ( Ch , p ) Floppy: To save marked images to floppy disk CD/DVD: To write marked images to CD or DVD USB: To save marked images to a USB storage device DICOM Store: To save marked images to a DICOM server ( Ch , p ) Any action which is performed affects exclusively the marked images, or the image where the cursor is. There are, however, a few exceptions to this rule: Delete protection: You can only protect the image where the cursor is. Delete: You can delete either all marked images, or all unmarked images, or only the image where the cursor is. As soon as the marked images have been output on a printer or saved to a storage medium, they will automatically become unmarked. Protected images, however, will remain delete-protected even after output. CD writer or DVD writer Depending on the chosen configuration, your may be equipped with a CD writer or alternatively with a DVD writer. With a CD writer, data can be written to or retrieved from CDs only. With a DVD writer, data can be written to or retrieved from both CDs and DVDs

117 10 Data Management Images that have been saved to a floppy disk or a USB storage device or written to CD or DVD cannot be re-imported from the storage medium into the system. For opening and processing these externally saved images, you need a separate PC which is equipped with the appropriate drives and software. Further processing Images in the following graphics formats have a file size of approx. 2 MB: 8 bit BMP 16 bit TIF DICOM Multimedia Besides that, you may also save the images with reduced resolution and color depth in the following formats: DICOM Bit JPEG Images with reduced resolution and color depth have a file size of approx. 256 KB (1/4 MB). Image file sizes To display an image at full-screen size on the live monitor, do the following: Select the desired image in the thumbnail mosaic on the reference monitor using the arrow buttons. Full-screen image Press the OK button. The selected image is displayed at full-screen size on the live monitor. Simultaneously, the displayed patient folder is activated. To display an image at full-screen size on the reference monitor, do the following: Select the desired image in the thumbnail mosaic on the reference monitor using the arrow buttons. Press the Full-Screen Image button. The selected image is displayed at full-screen size on the reference monitor. The Mosaic button appears, enabling you to restore the mosaic view on the reference monitor. To mark one or more images, do the following: Select the desired image on the reference monitor using the arrow buttons. Marking 10-23

118 10 Data Management Press the Mark button. The image is now marked and receives the label M. If you want to mark further images in addition, repeat the procedure. To unmark an image, do the following: Select the desired marked image on the reference monitor using the arrow buttons. Press the Mark button. The image becomes unmarked. Protecting To protect one or more images, do the following: Select the desired image on the reference monitor using the arrow buttons. Press the Protect button. The image is now delete-protected and receives the label P. If you want to protect further images, repeat the procedure. To unprotect an image, do the following: Select the desired protected image using the arrow buttons. Press the Protect button. The image becomes unprotected. Note Patient folders containing protected images cannot be deleted automatically. If many folders on the hard disk contain protected images, the auto-delete function ( p. 8-11) may not be working properly, and you will be unable to save new images. To avoid this situation, regularly back up the patient folders which are still needed to external storage media or to a DICOM server. You can then manually delete those patient folders or unprotect them and allow the auto-delete function to free up space on your hard disk

119 10 Data Management To delete one or more images from a patient folder, do the following: Deleting CAUTION Deleted images are irretrievably lost. Back up the images you want to delete or make sure that they are really no longer needed. Mark the images you want to delete and press the Delete Marked Items button. The following confirmation prompt is displayed: or or Mark the images you do not want to delete and press the Delete Unmarked Items button. The following confirmation prompt is displayed: or or Use the arrow buttons to select an individual image you want to delete and press the Delete button. The following confirmation prompt is displayed: Confirm by pressing the Yes button

120 10 Data Management The images are deleted from the patient folder. If you happen to select protected images, only the unprotected ones will be deleted, and the following message appears on the control panel: Protected images have not been deleted! Printing on video printer You can mark one or more images in the patient folder and print them all in one go. Besides, you can print the image displayed on the live monitor ( Ch. 8.8, p. 8-12). To print out images on the video printer, do the following: Position the cursor on the desired image, or mark the images you want to print. Press the Print button. The marked images are printed on the video printer mounted in the monitor cart. A progress indicator in a message window on the control panel informs you about the status of the print operation. The Cancel button appears, enabling you to interrupt the print operation. Once they have been printed, the images become unmarked. To print out the live monitor image on the video printer, do the following: Press the Print Live Monitor Image button. The image displayed on the live monitor is printed. Saving to floppy disk You can save images to floppy disk in 8 bit BMP format only. The floppy disk must have been preformatted on an external MS DOS compatible PC. The floppy disk drive which is mounted in the system does not support formatting. To save an image to floppy disk, do the following: Position the cursor on the desired image. Insert a formatted floppy disk into the floppy disk drive mounted in the monitor cart. Press the Floppy Disk button. The marked image is saved to the floppy disk. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Once it has been saved, the image becomes unmarked

121 10 Data Management You can save images to a standard USB storage device in the following formats: TIF with 16 bit color depth JPEG with a resolution of pixels and 8 bit color depth DICOM DICOM with a resolution of pixels and 8 bit color depth The storage format is defined in the Configuration operating mode under Storage Media ( Ch , p ). Saving to USB storage device Whenever you save images in standard DICOM format or reduced DICOM format (with a resolution of pixels and 8 bit color depth) to a USB storage device, the Ziehm DICOM Viewer program is automatically saved to the USB storage device as well. This program enables you to view the DICOM images on any PC with Microsoft Windows operating system (version Microsoft Windows 98 or higher). Ziehm DICOM Viewer To save images to a USB storage device, do the following: Position the cursor on the desired image, or mark the images you want to save. Plug the USB storage device into the USB port on the monitor cart. Press the USB button. The marked images are saved to the USB storage device. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Once they have been saved, the images become unmarked. You can write images to CD or DVD in the following formats: TIF with 16 bit color depth JPEG with a resolution of pixels and 8 bit color depth DICOM DICOM with a resolution of pixels and 8 bit color depth Multimedia (Video CD or MPEG2 format) The storage format is defined in the Configuration operating mode under Storage Media ( Ch , p ). Writing to CD or DVD 10-27

122 10 Data Management Ziehm DICOM Viewer Whenever you write images in standard DICOM format or reduced DICOM format (with a resolution of pixels and 8 bit color depth) to a CD/DVD, the Ziehm DICOM Viewer program is automatically written to the CD/DVD as well. This program enables you to view the DICOM images on any PC with Microsoft Windows operating system (version Microsoft Windows 98 or higher). To write images to CD or DVD, do the following: Position the cursor on the desired image, or mark the images you want to write to CD or DVD. Insert a CD or DVD into the CD or DVD writer mounted in the monitor cart. Press the CD/DVD button. The following messages appear one after the other: Checking CD/DVD... Write images to CD/DVD? Confirm by pressing the Yes button. A progress indicator in a message window on the control panel informs you about the status of the write operation. The Cancel button appears, enabling you to interrupt the write operation. Once the write operation has been completed successfully, the following message is displayed: Writing of CD/DVD completed successfully Press the OK button. Once they have been written to CD or DVD, the images become unmarked

123 10 Data Management Comparing saved images You may display saved images either from one patient folder or from several different patient folders at full-screen size on the live and reference monitor and compare them to each other. To compare two images from the same patient folder, do the following: Activate the Archive operating mode. Display the desired patient folder ( Ch , p ). Select the desired image on the reference monitor using the arrow buttons. Press the OK button. The image is displayed at full-screen size on the live monitor. Using the arrow buttons, select the second desired image and press the Full-Screen Image button. The second image is displayed at full-screen size on the reference monitor. The Mosaic button appears, enabling you to restore the mosaic view on the live monitor. You may compare the two images now. To compare two images from different patient folders, do the following: Activate the Archive operating mode. Display the desired patient folder ( Ch , p ). Select the desired image on the reference monitor using the arrow buttons. Press the OK button. The image is displayed at full-screen size on the live monitor. Press the Back button. Display the desired second patient folder ( Ch , p ). Using the arrow buttons, select the second desired image and press the Full-Screen Image button. The second image is displayed at full-screen size on the reference monitor. The Mosaic button appears, enabling you to restore the mosaic view on the live monitor

124 10 Data Management You may compare the two images now Making backup copies of patient folders You can back up the patient folders stored on the hard disk to a USB storage device or a CD/DVD. To select the patient folders you want to back up, you can use different search criteria (Last Name, Patient ID, Subject) and/or the image creation date. You can combine all these search criteria and also the image creation date (if desired) using an AND operation. Thus, you could e.g. search for and back up all patients called Miller with the subject Knee. Fig Archive Backup operating mode Selecting patient folders You can back up only entire patient folders with all images contained in them. To determine which folders are to be backed up, you use the image creation date and certain search criteria: Selection using the image creation date When you enter e.g. a period between YYYY and YYYY, all patient folders containing images that were created between January 1, YYYY and January 31, YYYY will be backed up. These folders are backed up in their entirety, including the images that were not created within the specified period of time. Selection using search criteria You can specify the patient folders you want to back up by entering the patient name (Last Name), patient number (Patient ID) and/or the Subject as search criteria

125 10 Data Management The search criteria and the time period are automatically combined by an AND operation. In addition, you can back up all patient folders to the chosen storage medium Backup to USB storage device The maximum number of images that fit on a USB storage device depends on the storage capacity of the device used as well as the percentage of images with reduced resolution and color depth ( p ). To be able to back up images on a USB storage device, the latter must be empty. Storage capacity During backup, the system will check automatically whether the remaining disk space is sufficient for the next folder to be backed up. If the folder is too large to fit on the connected USB storage device, you will be prompted by a message to plug another USB storage device into the USB port. You can restore the data which has been backed up to a USB storage device to the system s hard disk at any time ( p ). If the backup copy has been distributed to several USB storage devices, you must plug in the USB storage devices in the same order as during the backup procedure for restoring the data. Restoring backedup data To back up selected patient folders to a USB storage device, do the following: Press the Archive tab. The Archive operating mode is activated. Press the Backup button. The backup setting buttons are displayed in the dynamic control area. The Start Date input box contains by default the date The End Date input box contains by default the current date. Fig Backup setting buttons 10-31

126 10 Data Management Plug a USB storage device into the USB port. Now you can enter the desired search string(s). Press the Last Name button and enter a search string in the related input box. Note The search function is not case-sensitive. With each letter you enter, the alphabetical hit list is more and more confined to match the search string. The All button appears, allowing you to re-display the entire list. If desired, press the Patient ID button and enter a patient number in the related input box. If desired, press the Subject button and enter a search string in the related input box. If you want to confine the image creation period, press the Start Date button and enter another date in the related input box. If you want to confine the image creation period, press the End Date button and enter another date in the related input box. Press the Show Selected button. Press the USB button. All patient folders shown on the list are backed up to the USB storage device. A progress indicator in a message window informs you about the status of the backup operation. If there is not enough disk space left on the connected USB storage device, the following message appears: Please plug in another USB storage device. Plug another USB storage device into the USB port. Make sure to label the USB storage devices so that you can later identify the order in which they were connected. To back up all patient folders to a USB storage device, do the following: Press the Archive tab. The Archive operating mode is activated. Press the Backup button. The backup setting buttons are displayed in the dynamic control area. The Start Date input box contains by default the date The End Date input box contains by default the current date. This period covers all possible image data

127 10 Data Management Fig Backup setting buttons Plug a USB storage device into the USB port. Press the USB button. All patient folders are backed up to the USB storage device. A progress indicator in a message window informs you about the status of the backup operation. If there is not enough disk space left on the connected USB storage device, the following message appears: Please plug in another USB storage device. Plug another USB storage device into the USB port. Make sure to label the USB storage devices so that you can later identify the order in which they were connected. To restore backed-up data from a USB storage device to the hard disk, do the following: Press the Archive tab. The Archive operating mode is activated. Plug the USB storage device that contains the first part of the backup copy into the USB port. Press the Restore USB button. All patient folders and images that have been backed up to the USB storage device before are restored and saved to the system s hard disk. All restored patient folders are re-created on the hard disk, in addition to the already existing ones. Plug all further USB storage devices used for the backup into the USB port (if applicable). Make sure to connect them in the same order as during the backup procedure

128 10 Data Management Backup to CD or DVD Storage capacity A CD can store up to 320 images or up to 2,500 images with reduced resolution and color depth ( p ). The maximum number of images depends on the percentage of images with reduced resolution and color depth. Since the contents of a patient folder cannot be distributed to several CDs, it is not possible to back up patient folders that contain more than 250 images or 2,500 images with reduced resolution and color depth. A DVD can store up to 2,000 images or up to 8,000 images with reduced resolution and color depth ( p ). The maximum number of images depends on the percentage of images with reduced resolution and color depth. Since the contents of a patient folder cannot be distributed to several DVDs, it is not possible to back up patient folders that contain more than 2,000 images or 8,000 images with reduced resolution and color depth. During backup, the system will check automatically whether the remaining disk space is sufficient for the next folder to be backed up. If the folder is too large to fit on the CD or DVD in the drive, you will be prompted by a message to insert another CD or DVD into the drive. Restoring backedup data You can restore the data which has been backed up to CD or DVD to the system s hard disk at any time ( p ). If the backup copy has been distributed to several CDs or DVDs, you must insert the CDs or DVDs in the same order as during the backup procedure for restoring the data. To back up selected patient folders to CD or DVD, do the following: Press the Archive tab. The Archive operating mode is activated. Press the Backup button. The backup setting buttons are displayed in the dynamic control area. The Start Date input box contains by default the date The End Date input box contains by default the current date. Fig Backup setting buttons Insert an empty CD or DVD into the CD or DVD writer. Now you can enter the desired search string(s)

129 10 Data Management Press the Last Name button and enter a search string in the related input box. Note The search function is not case-sensitive. With each letter you enter, the alphabetical hit list is more and more confined to match the search string. The All button appears, allowing you to re-display the entire list. If desired, press the Patient ID button and enter a patient number in the related input box. If desired, press the Subject button and enter a search string in the related input box. If you want to confine the image creation period, press the Start Date button and enter another date in the related input box. If you want to confine the image creation period, press the End Date button and enter another date in the related input box. Press the Show Selected button. Press the CD/DVD button. The following message appears: Checking CD/DVD... All patient folders shown on the list are backed up to the CD or DVD. A progress indicator in a message window informs you about the status of the backup operation. If there is not enough disk space left on the inserted CD or DVD, the following message appears: Please insert new CD/DVD. Insert another CD or DVD. Make sure to label the CDs or DVDs so that you can later identify the order in which they were inserted. Once the write operation has been completed successfully, the following message is displayed: Writing of CD/DVD completed successfully Press the OK button. To back up all patient folders to CD or DVD, do the following: Press the Archive tab. The Archive operating mode is activated. Press the Backup button. The backup setting buttons are displayed in the dynamic control area. The Start Date input box contains by default the date The End Date input box contains by default the current date. This period covers all possible image data

130 10 Data Management Fig Backup setting buttons Insert an empty CD or DVD into the CD or DVD writer. Press the CD/DVD button. The following message appears: Checking CD/DVD... All patient folders are backed up to the CD or DVD. A progress indicator in a message window informs you about the status of the backup operation. If there is not enough disk space left on the inserted CD or DVD, you will be prompted to insert another disk into the drive: Please insert new CD/DVD. Insert another CD or DVD. Make sure to label the CDs or DVDs so that you can later identify the order in which they were inserted. Once the write operation has been completed successfully, the following message is displayed: Writing of CD/DVD completed successfully Press the OK button. To restore backed-up data from a CD or DVD to the hard disk, do the following: Press the Archive tab. The Archive operating mode is activated. Insert the CD or DVD that contains the first part of the backup copy into the CD or DVD writer. Press the Restore CD/DVD button. All patient folders and images which have been backed up to the CD or DVD before are restored and saved to the system s hard disk. All restored patient folders are re-created on the hard disk, in addition to the already existing ones. Insert all further CDs or DVDs used for the backup into the corresponding drive (if applicable). Make sure to insert them in the same order as during the backup procedure

131 DICOM Functions Prerequisites Depending on the DICOM Classes integrated in the system ( Ch. 2.3, p. 2-4), you can use certain DICOM functions. To be able to do so, the system must be connected to a DICOM network Downloading patient data from a DICOM server When creating a new patient folder ( Ch , p. 10-3), you can download the patient data from the DICOM server (Query or Worklist). The following prerequisites must be given: The must be connected to a DICOM server. The desired patient data must be stored on the DICOM server already. You must know the patient ID of the respective patient. Prerequisites Query The Query DICOM function enables you to download a patient s data (e.g. first name, last name) from the DICOM server. CAUTION If you use the patient ID to search for a patient folder, please verify the search result by checking the patient name. It may happen occasionally that a patient ID is assigned more than once on a DICOM network. To download patient data from a DICOM server, do the following: Press the Patient tab. The Patient operating mode is activated. Note You may predefine default data for the Hospital, Department and Doctor input boxes. The desired data is entered in the Configuration operating mode under Basic Settings. 11-1

132 11 DICOM Functions Press the New button. The input boxes are cleared (if any data has been displayed before in them), with the exception of those with default data ( Ch , p ). Press the Patient ID button and enter the patient ID of the patient you are looking for. The patient ID is displayed in the Patient ID box. Press the Query button. The patient data record is downloaded from the DICOM server and appears automatically in the input boxes. If necessary, complete any missing data. Save the new patient folder and the downloaded data by pressing the Save button. The new patient folder is automatically activated. A blank fluoroscopy mask with the downloaded patient data appears on the live monitor Downloading a Worklist Contents of the Worklist You can download a specific Worklist from the DICOM server. The Worklist contains the patient data as well as the examinations which are scheduled for the patient. Time span of the Worklist You can use a filter to determine the time span that is covered by the Worklist. The following filter criteria are available for that purpose: Default setting: Today (0:00 a.m. 12:00 p.m.) Yesterday (0:00 a.m. 12:00 p.m.) Yesterday and today (0:00 a.m. 12:00 p.m.) Now +/ 8 hours Filters for Worklist download Besides you can limit the contents of the Worklist to be downloaded using the following criteria: Patient Name (Last Name) Patient ID (Patient ID) Hospital-specific internal administrative number (Access. No.) Specific procedure step (Req. Proc. ID) Opening the Worklist offline Once you have downloaded the Worklist of the current day, you can open it as often as you like, even if the is no longer connected to the DICOM server. In this case, the word OFFLINE appears in the Worklist on the monitor. 11-2

133 11 DICOM Functions When you try to open a Worklist in offline mode although no Worklist has been downloaded for the current day from the DICOM server yet, the message No connection to server appears, and no Worklist is displayed Downloading a Worklist for a specific time span To download a Worklist that covers a specific time span from a DICOM server, do the following: Press the Patient tab. The Patient operating mode is activated. Press the Worklist button. The filter criteria for limiting the contents of the Worklist to be downloaded are displayed. If you already specified a patient name (Name), patient ID (Patient ID) or a hospital-specific internal administrative number (Access. No.) in the Patient operating mode, this data appears automatically in the corresponding boxes. Fig Filter criteria for limiting the Worklist contents Select the time span to be covered by the Worklist. If there is any data displayed in the Name, Patient ID and/or Access. No. boxes, press the Delete button. The Name, Patient ID and/or Access. No. boxes are cleared. Press the Worklist button. The data of all patients scheduled for the specified time span is downloaded from the DICOM server. A list of all downloaded data appears on the control panel. 11-3

134 11 DICOM Functions Fig DICOM Worklist Select the desired item on the list using the arrow buttons. Press the Apply button. The downloaded patient data appears in the input boxes of the Patient operating mode. The new patient folder is automatically activated. A blank fluoroscopy mask with the downloaded patient data appears on the live monitor. If necessary, complete any missing data. If you have completed any missing data, save the new patient folder by pressing the Save button Downloading a patient-specific Worklist CAUTION If you use the patient ID to search for a patient folder, please verify the search result by checking the patient name. It may happen occasionally that a patient ID is assigned more than once on a DICOM network. To download a patient-specific Worklist from a DICOM server, do the following: Press the Patient tab. The Patient operating mode is activated. Press the Name button and enter the last name of the desired patient. 11-4

135 11 DICOM Functions Press the Patient ID button and enter the patient ID of the desired patient. Press the Access No. button and enter the hospital-specific internal administrative number of the desired patient. Press the Worklist button. The filter criteria for limiting the contents of the Worklist to be downloaded are displayed. Any data you have already entered in the Name, Patient ID or Access. No. boxes appears automatically in the corresponding boxes. Fig Filter criteria for limiting the Worklist contents If you want to limit the time span covered by the Worklist to be downloaded, select the desired time span. Press the Worklist button. The data of the selected patient is downloaded from the DICOM server. A list with all patient-specific data downloaded appears on the control panel. If you have entered a name or the first letter(s) of a name as filter criterion, all matching items are listed. 11-5

136 11 DICOM Functions Fig Patient-specific Worklist Select the desired item on the list using the arrow buttons. Press the Apply button. The downloaded patient data appears in the input boxes of the Patient operating mode. The new patient folder is automatically activated. A blank fluoroscopy mask with the downloaded patient data appears on the live monitor. If necessary, complete any missing data. If you have completed any missing data, save the new patient folder by pressing the Save button Downloading a Worklist for a procedure step To download a Worklist that refers to a specific procedure step from a DICOM server, do the following: Press the Patient tab. The Patient operating mode is activated. Press the Worklist button. The filter criteria for limiting the contents of the Worklist to be downloaded are displayed. If you already specified a patient name (Name), patient ID (Patient ID) or a hospital-specific internal administrative number (Access. No.) in the Patient operating mode, this data appears automatically in the corresponding boxes. 11-6

137 11 DICOM Functions Fig Filter criteria for limiting the Worklist contents Press the Req. Proc. ID button and enter the ID of the desired procedure step. If there is any data displayed in the Name, Patient ID and/or Access. No. boxes, press the Delete button. The Name, Patient ID and/or Access. No. boxes are cleared. Press the Worklist button. The data of the specified procedure step is downloaded from the DICOM server. The cursor is automatically positioned on the list item. 11-7

138 11 DICOM Functions Fig Worklist for a procedure step Press the Apply button. The downloaded patient data appears in the input boxes of the Patient operating mode. The new patient folder is automatically activated. A blank fluoroscopy mask with the downloaded patient data appears on the live monitor. If necessary, complete any missing data. If you have completed any missing data, save the new patient folder by pressing the Save button Saving images from one or several patient folders DICOM Store If the system is connected to a DICOM network, you can save images from one or more patient folders to a DICOM server. Transferring images If you send only images to the DICOM server which are not stored there already, all images are actually transferred and saved. Images that are already stored on the DICOM server are not saved there again. Images that have been downloaded from the DICOM server with the Retrieve function will not be re-transferred to the DICOM server. CAUTION Never modify any patient data in a patient folder after having transferred images from this patient folder to the DICOM server! 11-8

139 11 DICOM Functions To save all images from one or several patient folders to a DICOM server, do the following: Press the Archive tab. The Archive operating mode is activated. Position the cursor on the desired patient folder, or mark the desired patient folders. Press the DICOM Store button. The marked patient folders are transferred to the DICOM server and saved there. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Images that have been successfully transferred receive the label D. Once they have been transferred, the patient folders become unmarked Saving and printing images and cine loops Once you have displayed or activated a patient folder, you can save the images and cine loops which are stored there to the DICOM server and/ or print them on a DICOM network printer. For information on generating cine loops, see Ch. 12, p To print out images or cine loops on a DICOM network printer, do the following: Press the Archive tab. The Archive operating mode is activated. Display the desired patient folder ( Ch , p ). or Activate the desired patient folder ( Ch , p ). Position the cursor on the desired image or cine loop. or or Mark the images or cine loops you want to print. 11-9

140 11 DICOM Functions Press the DICOM Print button. The marked images or cine loops are printed on the DICOM network printer. A progress indicator in a message window on the control panel informs you about the status of the print operation. The Cancel button appears, enabling you to interrupt the print operation. Once they have been printed, the images or cine loops become unmarked. To save images or cine loops to a DICOM server, do the following: Press the Archive tab. The Archive operating mode is activated. Display the desired patient folder ( Ch , p ). or Activate the desired patient folder ( Ch , p ). Position the cursor on the desired image or cine loop. or or Mark the images or cine loops you want to save. Press the DICOM Store button. The marked images or cine loops are transferred to the DICOM server and saved there. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Images that have been successfully transferred receive the label D. Once they have been saved, the images or cine loops become unmarked

141 11 DICOM Functions 11.4 Saving or printing single cine loop images If the system is connected to a DICOM network, you can save one or several single images from an open cine loop to the DICOM server and/ or print them on a DICOM network printer. To print out images from a cine loop on a DICOM network printer, do the following: Press the Archive tab. The Archive operating mode is activated. Open the desired cine loop ( Ch. 12.3, p. 12-4). The individual images of the cine loop are displayed as a thumbnail image mosaic on the reference monitor. Position the cursor on the desired image. or or Mark the images you want to print. Press the DICOM Print button. The marked images are printed on the DICOM network printer. A progress indicator in a message window on the control panel informs you about the status of the print operation. The Cancel button appears, enabling you to interrupt the print operation. Once they have been printed, the images become unmarked. To save cine loop images to a DICOM server, do the following: Press the Archive tab. The Archive operating mode is activated. Open the desired cine loop ( Ch. 12.3, p. 12-4). The individual images of the cine loop are displayed as a thumbnail image mosaic on the reference monitor. Position the cursor on the desired image. or or 11-11

142 11 DICOM Functions Mark the images you want to save. Press the DICOM Store button. The marked images are transferred to the DICOM server and saved there. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Images that have been successfully transferred receive the label D. Once they have been transferred, the images become unmarked Importing images and cine loops from a DICOM server After displaying or activating a patient folder in the Archive or Patient operating mode, you can download images and cine loops (image level query/retrieve) or entire series of images and cine loops (series level query/retrieve) from the connected DICOM server and save them to the displayed or active patient folder. You can download images and cine loops with a size of up to 27 MB from the DICOM server. The maximum number of images in each patient folder is not limited as long as the overall storage capacity of the system is not exceeded. or To import one or more images from the DICOM server into a patient folder, do the following: Press the Archive tab. The Archive operating mode is activated. or Press the Patient tab. The Patient operating mode is activated. Display the desired patient folder ( Ch , p ). or Activate the desired patient folder ( Ch , p ). Press the Retrieve or DICOM Retrieve button. The Studies, Series and Images lists with the related buttons are displayed on the control panel. The Studies list contains all studies which are available on the server

143 11 DICOM Functions Fig Studies, Series and Images retrieval lists, with items on the Studies list Select the desired study from the Studies list using the arrow buttons. Press the Refresh button next to the Studies list. All series of the selected study appear in the Series list. Fig Studies, Series and Images retrieval lists, with items on the Studies and Series lists 11-13

144 11 DICOM Functions Using the arrow buttons, position the cursor on the desired series in the Series list. Press the Refresh button next to the Series list. All images of the selected series are displayed in the Images list. Fig Studies, Series and Images retrieval lists, with items on all lists or Using the arrow buttons, position the cursor on the image of the Images list you want to import. or Mark the images you want to import in the Images list. Fig Images list with marked item Press the Retrieve button next to the Images list. The marked images are downloaded from the DICOM server to the patient folder. A progress indicator in a message window on the control panel informs you about the status of the transfer operation. Images that have been successfully downloaded receive the label R

145 11 DICOM Functions CAUTION Do not switch off the system during image data transfer! The transfer time depends on the network interface card and the network load. To import a series of images from the DICOM server into a patient folder, do the following: Press the Archive tab. The Archive operating mode is activated. or or Press the Patient tab. The Patient operating mode is activated. Display the desired patient folder ( Ch , p ). or Activate the desired patient folder ( Ch , p ). Press the Retrieve or DICOM Retrieve button. The Studies, Series and Images lists with the related buttons are displayed on the control panel. The Studies list contains all studies which are available on the server. Fig Studies, Series and Images retrieval lists, with items on the Studies list Select the desired study from the Studies list using the arrow buttons

146 11 DICOM Functions Press the Refresh button next to the Studies list. All series of the selected study appear in the Series list. Fig Studies, Series and Images retrieval lists, with items on the Studies and Series lists Using the arrow buttons, position the cursor in the Series list on the series whose images you want to import. Press the Retrieve button. The images of the series are downloaded from the DICOM server to the patient folder. A progress indicator in a message window on the control panel informs you about the status of the transfer operation. Images that have been successfully downloaded receive the label R. CAUTION Do not switch off the system during image data transfer! The transfer time depends on the network interface card and the network load

147 Cine Loops Overview A cine loop consists of several fluoroscopic images that are acquired in sequence. It can be replayed like a movie later and also post-edited. General Cine loops are useful whenever dynamic movement needs to be visualized. Typical fields of application are: Orthopedics: You can generate a cine loop for visualizing movements of the skeletal system. Vascular surgery: You can combine a cine loop with DSA ( Ch. 13.2, p. 13-2) to visualize a contrast medium flow. Applications 12.2 Generating a cine loop You can define the recording speed (frame rate) and the length (number of images) of the sequence for each cine loop you want to acquire. With a maximum system configuration of the, the following values are available: Recording speed: 1, 2, 4, 8, 12.5 or 25 frames per second (on systems with 25 frames/second) 1, 2, 5, 10, 15 or 30 frames per second (on systems with 30 frames/second and FD) Length: 100, 200, 300, 400 images per cine loop If you choose the option Auto, all images that are generated during radiation time are automatically saved. With this option, you do not need to determine the recording length prior to fluoroscopy. Settings 12-1

148 12 Cine Loops You can preset the recording speed and the length of the cine loop in the Configuration operating mode under Operation Settings ( Ch , p. 20-6). You can, however, modify these settings during operation for each individual cine loop you acquire. Fig Cine loop settings (on systems with 30 frames/s) Saving a cine loop The cine loop images are automatically saved during radiation. The first image of the cine loop is saved as the start image, the last one as the stop image. How many images are actually saved depends on the cine loop length you have chosen: If you terminate radiation before reaching the selected cine loop length, only the images generated during radiation time will be saved. If radiation is continued beyond the selected cine loop length, only the last images will be saved; the first images are lost. If you have chosen the Auto option, all images that are generated during radiation time are automatically saved. Storage capacity Before you initiate fluoroscopy, the system checks automatically whether there is enough hard disk space available for the preset cine loop. If, despite the auto-delete function ( p. 8-11), it is not possible to free up enough disk space, an audible alarm sounds and the following alert message appears on the control panel: Not enough space on hard disk. Required: xyz. Available: xyz. 12-2

149 12 Cine Loops To free up disk space for a cine loop, do the following: Unprotect all protected images of a stored patient folder ( p ) and then delete the patient folder from the hard disk. or Decrease the length of the cine loop you want to acquire. Make a backup to a USB storage device or a CD/DVD as soon as possible and then delete the patient folders you have backed up before from the hard disk. Note As long as the snapshot fluoroscopy mode is active, the Cine button is hidden on the control panel. To acquire a cine loop, do the following: Press the Cine button. The cine loop setting buttons are displayed in the dynamic control area. Fig Cine loop setting buttons on systems with 25 frames/s (left) and 30 frames/s (right) Select the desired cine loop length or the Auto function under Length. Select the desired recording speed under Frames/s. Initiate radiation. The cine loop is acquired and saved. Terminate radiation. The new cine loop is now automatically replayed at the preset frame rate in an endless loop on the live monitor. You can control and edit the cine loop ( Ch. 12.4, p. 12-6). 12-3

150 12 Cine Loops 12.3 Opening a saved cine loop You can re-open and replay a cine loop saved on the hard disk at any time. To open a cine loop saved on the hard disk, do the following: Press the Archive tab. The Archive operating mode is activated. Press the Search button. The input boxes for searching are displayed in the dynamic control area. A list of all patient names is displayed. Now you can enter the desired search string(s). Press the button of the desired input box, e.g. the Last Name button. The button is highlighted in yellow. The cursor jumps to the corresponding input box. Enter the search string using the alphanumeric keypad. Note The search function is not case-sensitive. With each letter you enter, the alphabetical list is more and more confined to match the search string. The All button appears, allowing you to re-display the entire list. Press the Back button. You are returned to the Archive screen. The data of all patients who match the search string(s) is displayed in the list. The All button appears, allowing you to re-display the entire list. Select the desired patient folder using the arrow buttons. Press the OK button. All images contained in this patient folder are displayed as thumbnails on the reference monitor. The most recent image is highlighted by a white frame. Cine loop sequences are symbolized by their last image and bear the label C. Select the desired cine loop in the patient folder using the arrow buttons. 12-4

151 12 Cine Loops Press the OK button. The first image of the cine loop is displayed at full-screen size on the live monitor. The cine loop number in the patient folder is shown in the image as CINE XY. The individual images of the cine loop are displayed as a thumbnail mosaic on the reference monitor. The buttons for controlling and editing a cine loop during playback and for processing and outputting individual cine loop images appear on the control panel: Buttons for controlling and editing the cine loop Buttons for processing and outputting cine loop images Fig Archive operating mode during cine loop playback (on systems with 30 frames/s) Press the Play button. The cine loop is replayed in an endless loop on the live monitor. During playback, a moving indicator shows the position of the currently displayed image within the cine loop. The buttons in the dynamic control area are used to control and edit the cine loop which is replayed on the live monitor ( Ch. 12.4, p. 12-6). If you have opened a DSA cine loop, additional buttons for editing are displayed in the dynamic control area. The buttons in the lower half of the control panel are used to process and output the individual images of the cine loop ( Ch. 12.6, p ). 12-5

152 12 Cine Loops 12.4 Controlling and editing a cine loop during playback As soon as a newly-acquired or saved cine loop is replayed on the live monitor, the buttons for controlling and editing the cine loop are displayed in the dynamic control area. When you replay a DSA cine loop, additional buttons for the following functions are displayed in the dynamic control area: Mask image control ( Ch. 13.6, p ) Pixel shift ( Ch. 13.7, p ) Landmarking ( Ch. 13.8, p ) Fig Buttons for controlling and editing a cine loop during playback (without DSA) on systems with 25 frames/s (above) and 30 frames/s (below) All the settings that you make in the dynamic control area always affect the cine loop which is marked by a white frame on the monitor. You can control cine loop playback in the following ways: Changing the cine loop speed To change the playback speed of the cine loop, choose another value under Frms/s. To stop cine loop playback, press the Stop button. The Play button appears. To scroll through the cine loop, press the Forward or Backward arrow button. The longer you press the button, the faster the cine loop images are opened one after the other. To continue cine loop playback, press the Play button. The Stop button appears. 12-6

153 12 Cine Loops The following options are available for editing a cine loop during playback: Editing options Trimming the cine loop Cleaning up the cine loop You can trim the cine loop for playback, e.g. if the contrast medium has been injected too late, thus making the first images of the cine loop useless. This is done by defining a new start image and a new stop image for cine loop playback. Trimming the cine loop To trim the cine loop, do the following: Press the Stop button. Now you can scroll through the individual images of the cine loop with the help of the arrow buttons. Select the desired start image using the arrow buttons. Press the Start Img button. Select the desired stop image using the arrow buttons. Press the Stop Img button. The cine loop sequence is trimmed. Press the Play button. The trimmed cine loop sequence is replayed in an endless loop. To replay the entire original cine loop, press the Complete button. You can delete all images outside the trimmed cine loop, i.e. those before the start image and those after the stop image. Cleaning up the cine loop Note Once you have cleaned up the cine loop, you can no longer restore the original cine loop with the Complete button. 12-7

154 12 Cine Loops To clean up a cine loop, do the following: Press the Stop button. Press the Clean up button. All images which are not enclosed between the start image and the stop image are deleted without confirmation prompt Processing and outputting saved cine loops Once you have displayed ( Ch , p ) or activated ( Ch , p ) a patient folder, you can process the images and the cine loops that are stored there. Different read-only boxes and buttons are displayed on the control panel for that purpose. In the mosaic on the reference monitor, cine loop sequences are symbolized by their last image and bear the label C. Readonly boxes Buttons for marking and deleting Arrow buttons for navigating on the monitor Buttons for printing Buttons for saving Fig Archive operating mode with displayed patient folder We will now discuss how to process and output cine loops. For information on how to process and output individual images in a patient folder, please refer to Ch , p The following cine loop processing functions are available in a displayed or active patient folder: Mark: To mark one or more cine loops 12-8

155 12 Cine Loops Protect: To protect marked cine loops against being deleted Delete: To delete cine loops DICOM Retrieve: To import cine loops from a DICOM server ( Ch. 11.5, p ) Print: To print out marked cine loops on the video printer DICOM Print: To print out marked cine loops on a DICOM network printer ( Ch , p. 11-9) Floppy: You cannot save a cine loop to floppy disk because a floppy disk stores only one image. CD/DVD: To write marked cine loops to CD or DVD USB: To save marked cine loops to a USB storage device DICOM Store: To save marked cine loops to a DICOM server ( Ch , p. 11-9) Any action which is performed affects exclusively the marked cine loops, or the cine loop where the cursor is. There are, however, a few exceptions to this rule: Delete protection: You can only protect the cine loop where the cursor is. Delete: You can delete either all marked cine loops, or all unmarked cine loops, or only the cine loop where the cursor is. As soon as marked cine loops have been output on a printer or saved to a storage medium, they will automatically become unmarked. Protected cine loops, however, will remain delete-protected even after output. 12-9

156 12 Cine Loops Image file sizes Images in the following graphics formats have a file size of approx. 2 MB: 8 bit BMP 16 bit TIF DICOM Multimedia Besides that, you may also save the images with reduced resolution and color depth in the following formats: DICOM Bit JPEG Images with reduced resolution and color depth have a file size of approx. 256 KB (1/4 MB). Further processing Cine loops that have been saved to a USB storage device or written to CD or DVD cannot be re-imported from the storage medium into the system. For opening and processing these externally saved cine loops, you need a separate PC which is equipped with the appropriate drives and software. Replaying a cine loop To replay a cine loop, do the following: Select the desired cine loop in the thumbnail mosaic on the reference monitor using the arrow buttons. Press the OK button. The start image of the cine loop is displayed on the live monitor. The individual images of the cine loop are displayed as a thumbnail mosaic on the reference monitor. The buttons for controlling and editing the selected cine loop ( Ch. 12.4, p. 12-6) and for processing and outputting single cine loop images ( Ch. 12.6, p ) appear on the control panel. Press the Play button. The cine loop is replayed on the live monitor

157 12 Cine Loops To mark one or more cine loops, do the following: Select the desired cine loop on the reference monitor using the arrow buttons. Marking Press the Mark button. The cine loop is now marked and receives the label M. If you want to mark further cine loops in addition, repeat the procedure. To unmark a cine loop, do the following: Select the desired marked cine loop on the reference monitor using the arrow buttons. Press the Mark button. The cine loop becomes unmarked. To protect one or more cine loops, do the following: Protecting Select the desired cine loop on the reference monitor using the arrow buttons. Press the Protect button. The cine loop is now protected and receives the label P. If you want to protect further cine loops, repeat the procedure. To unprotect a cine loop, do the following: Select the desired protected cine loop using the arrow buttons. Press the Protect button. The cine loop becomes unprotected. Note Patient folders containing protected cine loops or images cannot be deleted automatically. If many folders on the hard disk contain protected cine loops or images, the auto-delete function ( p. 8-11) may not be working properly, and you will be unable to save new images. To avoid this situation, regularly back up the patient folders which are still needed to external storage media or to a DICOM server. You can then manually delete those patient folders or unprotect them and allow the auto-delete function to free up space on your hard disk

158 12 Cine Loops Deleting To delete one or more cine loops from a patient folder, do the following: CAUTION Deleted cine loops are irretrievably lost. Back up the cine loops you want to delete or make sure that they are really no longer needed. Mark the cine loops you want to delete and press the Delete Marked Items button. The following confirmation prompt is displayed: or or Mark the cine loops you do not want to delete and press the Delete Unmarked Items button. The following confirmation prompt is displayed: or or Using the arrow buttons, position the cursor on the cine loop you want to delete, and then press the Delete button. The following confirmation prompt is displayed: Confirm by pressing the Yes button. The cine loops are deleted from the patient folder

159 12 Cine Loops You can mark one or more cine loops and print all images contained in them in one go. Besides, you can print the image displayed on the live monitor ( Ch. 8.8, p. 8-12). Printing on video printer To print out a cine loop on the video printer, do the following: Position the cursor on the desired cine loop or mark the cine loops you want to print. Press the Print button. The marked cine loops are output on the video printer mounted in the monitor cart. A progress indicator in a message window on the control panel informs you about the status of the print operation. The Cancel button appears, enabling you to interrupt the print operation. Once they have been printed, the cine loops become unmarked. To print out the live monitor image on the video printer, do the following: Press the Print Live Monitor Image button. The image displayed on the live monitor is printed. You can save cine loop images to a standard USB storage device in the following formats: TIF with 16 bit color depth JPEG with a resolution of pixels and 8 bit color depth DICOM DICOM with a resolution of pixels and 8 bit color depth The storage format is defined in the Configuration operating mode under Storage Media ( Ch , p ). Saving to USB storage device Whenever you save images in standard DICOM format or reduced DICOM format (with a resolution of pixels and 8 bit color depth) to a USB storage device, the Ziehm DICOM Viewer program is automatically saved to the USB storage device as well. This program enables you to view the DICOM images on any PC with Microsoft Windows operating system (version Microsoft Windows 98 or higher). Ziehm DICOM Viewer To save cine loops to a USB storage device, do the following: Position the cursor on the desired cine loop or mark the cine loops you want to save. Plug the USB storage device into the USB port on the monitor cart

160 12 Cine Loops Press the USB button. The marked cine loops are saved to the USB storage device. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Once they have been saved, the cine loops become unmarked. Writing to CD or DVD You can write cine loop images to CD or DVD in the following formats: TIF with 16 bit color depth JPEG with a resolution of pixels and 8 bit color depth DICOM DICOM with a resolution of pixels and 8 bit color depth Multimedia (Video CD or MPEG2 format) The storage format is defined in the Configuration operating mode under Storage Media ( Ch , p ). Ziehm DICOM Viewer Whenever you write images in standard DICOM format or reduced DICOM format (with a resolution of pixels and 8 bit color depth) to a CD/DVD, the Ziehm DICOM Viewer program is automatically written to the CD/DVD as well. This program enables you to view the DICOM images on any PC with Microsoft Windows operating system (version Microsoft Windows 98 or higher). To write cine loops to CD or DVD, do the following: Position the cursor on the desired cine loop or mark the cine loops you want to write to CD or DVD. Insert a CD or DVD into the CD or DVD writer mounted in the monitor cart. Press the CD/DVD button. The following messages appear one after the other: Checking CD/DVD... Write images to CD/DVD? Confirm by pressing the Yes button. A progress indicator in a message window on the control panel informs you about the status of the write operation. The Cancel button appears, enabling you to interrupt the write operation. Once the write operation has been completed successfully, the following message is displayed: Writing of CD/DVD completed successfully Press the OK button. Once they have been written to CD or DVD, the cine loops become unmarked

161 12 Cine Loops 12.6 Processing and outputting single cine loop images As soon as you open a saved cine loop in the Archive operating mode ( Ch. 12.3, p. 12-4), the individual images of the cine loop are displayed as a thumbnail mosaic on the reference monitor. When you place the cursor on an individual image of the thumbnail mosaic, this image is automatically displayed at full-screen size on the live monitor. The following functions are available for processing single images of a cine loop: Mark: To mark one or more images Protect: To protect images against being deleted Delete: To delete images Print: To print out marked images on the video printer DICOM Print: To print out marked images on a DICOM network printer ( Ch. 11.4, p ) Floppy: To save marked images to floppy disk CD/DVD: To write marked images to CD or DVD USB: To save marked images to a USB storage device DICOM Store: To save marked images to a DICOM server ( Ch. 11.4, p ) 12-15

162 12 Cine Loops Any action which is performed affects exclusively the marked images, or the image where the cursor is. There are, however, a few exceptions to this rule: Delete protection: You can only protect the image where the cursor is. Delete: You can delete either all marked images, or all unmarked images, or only the image where the cursor is. As soon as the marked images have been output on a printer or saved to a storage medium, they will automatically become unmarked. Protected images, however, will remain delete-protected even after output. Further processing Images that have been saved to a floppy disk or a USB storage device or written to CD or DVD cannot be re-imported from the storage medium into the system. For opening and processing these externally saved images, you need a separate PC which is equipped with the appropriate drives and software. Image file sizes Images in the following graphics formats have a file size of approx. 2 MB: 8 bit BMP 16 bit TIF DICOM Multimedia Besides that, you may also save the images with reduced resolution and color depth in the following formats: DICOM Bit JPEG Images with reduced resolution and color depth have a file size of approx. 256 KB (1/4 MB). Marking To mark one or more images of a cine loop, do the following: Select the desired image in the thumbnail mosaic on the live monitor using the arrow buttons. Press the Mark button. The image is now marked and receives the label M

163 12 Cine Loops If you want to mark further images in addition, repeat the procedure. To unmark an image, do the following: Select the desired marked image using the arrow buttons. Press the Mark button. To protect one or more images of a cine loop, do the following: Select the desired image in the thumbnail mosaic on the reference monitor using the arrow buttons. Protecting Press the Protect button. The image is now delete-protected and receives the label P. To protect further images, repeat the procedure. To unprotect an image, do the following: Select the desired protected image with the arrow buttons and press the Protect button. Note Patient folders containing protected images cannot be deleted automatically. If many folders on the hard disk contain protected images, the auto-delete function ( p. 8-11) may not be working properly, and you will be unable to save new images. To avoid this situation, regularly back up the patient folders which are still needed to external storage media or to a DICOM server. You can then manually delete those patient folders or unprotect them and allow the auto-delete function to free up space on your hard disk

164 12 Cine Loops Deleting To delete one or more images of a cine loop, do the following: CAUTION Deleted images are irretrievably lost. Back up the images you want to delete or make sure that they are really no longer needed. Mark the images you want to delete. Press the Delete Marked Items button. The following confirmation prompt is displayed: or or Mark the images you do not want to delete. Press the Delete Unmarked Items button. The following confirmation prompt is displayed: or or Select the individual image you want to delete using the arrow buttons. Press the Delete button

165 12 Cine Loops The following confirmation prompt is displayed: Confirm by pressing the Yes button. The images are deleted from the patient folder. You can mark one or more images of the cine loop and print them all in one go. Besides, you can print the image displayed on the live monitor ( Ch. 8.8, p. 8-12). Printing on video printer To print out images from a cine loop on the video printer, do the following: Position the cursor on the desired image, or mark the images you want to print. Press the Print button. The marked images are printed on the video printer mounted in the monitor cart. A progress indicator in a message window on the control panel informs you about the status of the print operation. The Cancel button appears, enabling you to interrupt the print operation. Once they have been printed, the cine loop images become unmarked. To print out the live monitor image on the video printer, do the following: Press the Print Live Monitor Image button. The image displayed on the live monitor is printed. You can save cine loop images to floppy disk in 8 bit BMP format only. The floppy disk must have been preformatted on an external MS DOS compatible PC. The floppy disk drive which is mounted in the system does not support formatting. Saving to floppy disk 12-19

166 12 Cine Loops To save a cine loop image to floppy disk, do the following: Position the cursor on the image you want to save. Insert a formatted floppy disk into the floppy disk drive mounted in the monitor cart. Press the Floppy button. The image is saved to the floppy disk. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Saving to USB storage device You can save cine loop images to a standard USB storage device in the following formats: TIF with 16 bit color depth JPEG with a resolution of pixels and 8 bit color depth DICOM DICOM with a resolution of pixels and 8 bit color depth The storage format is defined in the Configuration operating mode under Storage Media ( Ch , p ). Ziehm DICOM Viewer Whenever you save images in standard DICOM format or reduced DICOM format (with a resolution of pixels and 8 bit color depth) to a USB storage device, the Ziehm DICOM Viewer program is automatically saved to the USB storage device as well. This program enables you to view the DICOM images on any PC with Microsoft Windows operating system (version Microsoft Windows 98 or higher). To save cine loop images to a USB storage device, do the following: Position the cursor on the desired image, or mark the images you want to save. Plug the USB storage device into the USB port on the monitor cart. Press the USB button. The marked images are saved to the USB storage device. A progress indicator in a message window on the control panel informs you about the status of the save operation. The Cancel button appears, enabling you to interrupt the save operation. Once they have been saved, the cine loop images become unmarked. Writing to CD or DVD You can write cine loop images to CD or DVD in the following formats: TIF with 16 bit color depth JPEG with a resolution of pixels and 8 bit color depth DICOM 12-20

167 12 Cine Loops DICOM with a resolution of pixels and 8 bit color depth Multimedia (Video CD or MPEG2 format) The storage format is defined in the Configuration operating mode under Storage Media ( Ch , p ). Whenever you write images in standard DICOM format or reduced DICOM format (with a resolution of pixels and 8 bit color depth) to a CD/DVD, the Ziehm DICOM Viewer program is automatically written to the CD/DVD as well. This program enables you to view the DICOM images on any PC with Microsoft Windows operating system (version Microsoft Windows 98 or higher). Ziehm DICOM Viewer To write cine loop images to CD or DVD, do the following: Position the cursor on the desired image, or mark the images you want to write to CD or DVD. Insert a CD or DVD into the CD or DVD writer mounted in the monitor cart. Press the CD/DVD button. The following messages appear one after the other: Checking CD/DVD... Write images to CD/DVD? Confirm by pressing the Yes button. A progress indicator in a message window on the control panel informs you about the status of the write operation. The Cancel button appears, enabling you to interrupt the write operation. Once the write operation has been completed successfully, the following message is displayed: Writing of CD/DVD completed successfully Press the OK button. Once they have been written to CD or DVD, the cine loop images become unmarked

168 12 Cine Loops 12-22

169 Subtraction Modes Overview The provides three subtraction modes (DSA, MSA and RSA), which are used mainly in vascular surgery. As the generation of an MSA and/or RSA image requires a cine loop with DSA, MSA and RSA can be performed exclusively in conjunction with a DSA. Applications DSA (Digital Subtraction Angiography) mode generates a conventional subtracted image. This means that one image is subtracted from the other, so that only the differences between the images become visible. On the, DSA is always combined with a cine loop ( Ch. 12, p. 12-1). DSA MSA (Maximum Opacification Subtraction Angiography) mode generates a subtracted image showing the entire path of the contrast medium flow during the acquisition run with maximum contrast opacification. The MSA image is generated from the DSA cine loop without any additional radiation. MSA An RSA image (Roadmapping Subtraction Angiography) is generated in three steps: The MSA image is inverted. A new DSA image is generated. The new DSA image is superimposed over the inverted MSA image. Thus, during an interventional procedure, surgeons can clearly see where they are moving (e.g. with a catheter) within the contrast medium path generated. You can acquire as many RSA images as desired during one session. RSA Before acquiring a DSA cine loop, you must create or activate a patient folder. The DSA cine loop, the MSA image and the RSA images are saved to the active patient folder in the order in which they have been generated and may be re-opened or post-processed later. Saving 13-1

170 13 Subtraction Modes Image types In subtraction mode, three types of images are generated: Mask image The mask image is the fluoroscopic image from which the native images are subsequently subtracted. The mask image is always acquired first. Native image Generally speaking, a native image is an original fluoroscopic image without any modification. In the subtraction modes, the native image is the image which is subtracted from the mask image. Subtracted image A subtracted image is the result of the subtraction process: mask image minus native image. Showing or hiding the native image You can preset whether the native image shall appear on the reference monitor during the acquisition of a DSA cine loop, MSA image or RSA image. This is done in the Configuration operating mode under Operation Settings ( Ch , p. 20-7). If you deactivate the option DSA Native on, you may display a reference image on the reference monitor during the entire subtraction procedure. If you activate the option DSA Native on, any image which is displayed on the reference monitor will disappear as soon as you switch to the Subtraction operating mode. Cine loop Each DSA is automatically combined with a cine loop. The first image of the cine loop is saved as the mask image, and all subsequent native images are subtracted from the mask image Acquiring a DSA cine loop Prerequisite To be able to acquire a DSA cine loop, you must create a new patient folder ( Ch , p. 10-3) or activate an existing patient folder ( Ch , p ) first. Length of the DSA cine loop With a DSA cine loop, the system automatically saves all images that are generated during radiation time. In the DSA cine loop settings, the Auto option is preset. You cannot select a defined length for a DSA cine loop ( p. 12-2). To acquire a DSA cine loop, do the following: Press the Subtraction tab. The Subtraction operating mode is activated. 13-2

171 13 Subtraction Modes Press the DSA button. The cine loop setting buttons are displayed in the dynamic control area. The Auto option is preset under Length and cannot be changed. Set the desired frame rate for the DSA cine loop under Frms/s ( Ch. 12.2, p. 12-1). Press the hand switch or the left pedal of the two-pedal foot switch. The following message appears on the control panel: A countdown of 5 seconds is performed on the live monitor. After 2 seconds, radiation is released automatically. After the mask has been acquired, the request...injection appears on the title bar of the control panel. Inject the contrast medium. Cine loop acquisition continues. The subtracted images are displayed on the live monitor. If you have activated the function DSA Native on, the native images are displayed on the reference monitor. Terminate radiation. The cine loop is automatically saved to the active patient folder. It is replayed in an endless loop on the live monitor. The buttons for controlling and editing the cine loop ( Ch. 12.4, p. 12-6) as well as the MSA ( Ch. 13.3, p. 13-4), LM (landmarking, Ch. 13.8, p ) and P-Sh (pixel shift Ch. 13.7, p ) buttons appear in the dynamic control area. Fig Buttons for controlling and editing a DSA cine loop during playback on systems with 25 frames/s (left) and 30 frames/s (right) The Subtraction operating mode remains active. When you initiate radiation again, a new DSA cine loop is acquired with the defined settings. 13-3

172 13 Subtraction Modes Filter factors Various filter factors can be set for the DSA mode in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Please contact your service engineer if you wish to set or modify the filters for the DSA mode. Windowing values The initial windowing values (width and level of the contrast window) for the DSA mode can be set in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Please contact your service engineer if you wish to set or modify the windowing values for the DSA mode Acquiring an MSA image To acquire an MSA image, do the following: Generate a DSA cine loop ( Ch. 13.2, p. 13-2). The cine loop is replayed in an endless loop on the live monitor. The buttons for controlling and editing the cine loop as well as the MSA button appear in the dynamic control area. Fig Buttons for controlling and editing a DSA cine loop during playback on systems with 25 frames/s (left) and 30 frames/s (right) Press the MSA button. The following message appears on the control panel: An MSA image is generated without any further release of radiation. The MSA image is automatically saved to the active patient folder. The buttons for controlling and editing the cine loop disappear from the dynamic control area. The RSA button appears. 13-4

173 13 Subtraction Modes Fig Dynamic control area after the acquisition of an MSA image Various filter factors can be set for the MSA mode in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Filter factors Please contact your service engineer if you wish to set or modify the filters for the MSA mode. The initial windowing values (width and level of the contrast window) for the MSA mode can be set in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Windowing values Please contact your service engineer if you wish to set or modify the windowing values for the MSA mode Acquiring an RSA image To acquire an RSA image, do the following: Generate a DSA cine loop ( Ch. 13.2, p. 13-2). Generate an MSA image ( Ch. 13.3, p. 13-4). The RSA button appears in the dynamic control area. Fig Dynamic control area after the acquisition of an MSA image Press the RSA button. The RSA button disappears from the dynamic control area, and the buttons for landmarking ( Ch. 13.8, p ) and pixel shift ( Ch. 13.7, p ) appear instead. 13-5

174 13 Subtraction Modes Fig Dynamic control area in RSA mode Initiate radiation. A DSA image is generated. The MSA image is inverted, so that the contrast medium path appears white instead of black. The DSA image (not inverted) is superimposed over the MSA image. Terminate radiation. The combined last subtracted image remains displayed on the live monitor and is saved automatically to the patient folder. If you want to acquire another RSA image, initiate radiation again. You can acquire and save as many RSA images as you wish. Filter factors Various filter factors can be set for the RSA mode in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Please contact your service engineer if you wish to set or modify the filters for the RSA mode. Windowing values The initial windowing values (width and level of the contrast window) for the RSA mode can be set in the Configuration operating mode under Service Settings. You cannot make these presettings yourself. Please contact your service engineer if you wish to set or modify the windowing values for the RSA mode. 13-6

175 13 Subtraction Modes 13.5 Generating MSA and RSA images from a saved DSA cine loop You can open a saved DSA cine loop and generate an MSA image or RSA images later without having to re-inject any contrast medium. You can do this either in the active patient folder ( Ch , p. 13-7) or in any patient folder on your system ( Ch , p. 13-8) Opening and postprocessing a DSA cine loop in an active patient folder To generate MSA or RSA images from a saved DSA cine loop when the respective patient folder is already active, do the following: Activate the Subtraction operating mode. Use the arrow buttons to browse through the active patient folder. The images and cine loops which are stored in the patient folder are displayed at full-screen size on the reference monitor. Once you have opened the desired DSA cine loop, press the Image Swapping button. The first image of the DSA cine loop is displayed at full-screen size on the live monitor. The buttons for controlling and editing the cine loop as well as the MSA button appear in the dynamic control area. Fig Buttons for controlling and editing a DSA cine loop during playback on systems with 25 frames/s (left) and 30 frames/s (right) Press the MSA button. The following message appears on the control panel: An MSA image is generated without any further release of radiation. The MSA image is automatically saved to the active patient folder. The buttons for controlling and editing the cine loop disappear from the dynamic control area. The RSA button appears. 13-7

176 13 Subtraction Modes Fig Dynamic control area after the acquisition of an MSA image Press the RSA button. The RSA button disappears from the dynamic control area, and the buttons for landmarking ( Ch. 13.8, p ) and pixel shift ( Ch. 13.7, p ) appear instead. Fig Dynamic control area in RSA mode Initiate radiation. A DSA image is generated. The MSA image is inverted, so that the contrast medium path appears white instead of black. The DSA image (not inverted) is superimposed over the MSA image. Terminate radiation. The combined last subtracted image remains displayed on the live monitor and is saved automatically to the patient folder. If you want to acquire another RSA image, initiate radiation again. You can acquire and save as many RSA images as you wish Opening and postprocessing any DSA cine loop To generate MSA or RSA images from any saved DSA cine loop, do the following: Press the Archive tab. The Archive operating mode is activated. Select the desired patient folder using the arrow buttons. 13-8

177 13 Subtraction Modes Press the OK button. Select the desired DSA cine loop in the patient folder using the arrow buttons. Press the OK button. The buttons for controlling and editing the cine loop appear on the control panel. The Subtraction button appears in the dynamic control area. Fig Buttons for controlling and editing a DSA cine loop, including Subtraction button, on systems with 25 frames/s (above) and 30 frames/s (below) Press the Subtraction button in the dynamic control area. The buttons for controlling and editing the cine loop as well as the MSA button appear in the dynamic control area. Fig Buttons for controlling and editing a DSA cine loop during playback on systems with 25 frames/s (left) and 30 frames/s (right) Press the MSA button. The following message appears on the control panel: 13-9

178 13 Subtraction Modes An MSA image is generated without any further release of radiation. The MSA image is automatically saved to the active patient folder. The buttons for controlling and editing the cine loop disappear from the dynamic control area. The RSA button appears. Fig Dynamic control area after the acquisition of an MSA image Press the RSA button. The RSA button disappears from the dynamic control area, and the buttons for landmarking ( Ch. 13.8, p ) and pixel shift ( Ch. 13.7, p ) appear instead. Fig Dynamic control area in RSA mode Initiate radiation. A DSA image is generated. The MSA image is inverted, so that the contrast medium path appears white instead of black. The DSA image (not inverted) is superimposed over the MSA image. Terminate radiation. The combined last subtracted image remains displayed on the live monitor and is saved automatically to the patient folder. If you want to acquire another RSA image, initiate radiation again. You can acquire and save as many RSA images as you wish

179 13 Subtraction Modes 13.6 Editing a DSA cine loop As soon as a newly-acquired ( Ch. 13.2, p. 13-2) or saved ( Ch. 12.3, p. 12-4) DSA cine loop is replayed on the live monitor, the buttons for controlling and editing the cine loop are displayed in the dynamic control area. Fig Buttons for controlling and editing a DSA cine loop during playback on systems with 25 frames/s (left) and 30 frames/ s (right) All the settings that you make in the dynamic control area always affect the cine loop which is marked by a white frame on the monitor. You can control cine loop playback in the following ways: To change the playback speed of the cine loop, choose another value under Frms/s. To stop cine loop playback, press the Stop button. The Play button appears. Changing the cine loop speed To continue cine loop playback, press the Play button. The Stop button appears. The following options are available for editing a cine loop during playback: Editing options Trimming the cine loop Cleaning up the cine loop Defining another mask image You can trim the cine loop for playback, e.g. if the contrast medium has been injected too late, thus making the first images of the cine loop useless. This is done by defining a new start image and a new stop image for cine loop playback. Trimming the cine loop 13-11

180 13 Subtraction Modes To trim the cine loop, do the following: Press the Stop button. Now you can scroll through the individual images of the cine loop with the help of the arrow buttons. Select the desired start image with the arrow buttons and press the Start Img button. Select the desired stop image with the arrow buttons and press the Stop Img button. The cine loop sequence is trimmed. Press the Play button. The trimmed cine loop sequence is replayed in an endless loop. To replay the entire original cine loop, press the Complete button. Cleaning up the cine loop You can delete all images outside the trimmed cine loop, i.e. those before the start image and those after the stop image. Note Once you have cleaned up the cine loop, you can no longer restore the original cine loop with the Complete button. To clean up a cine loop, do the following: Press the Stop button. Press the Clean up button. All images which are not enclosed between the start image and the stop image are deleted without confirmation prompt. Defining a mask image You can define a mask image other than the original one for a DSA cine loop ( p. 13-2). To define an image of the cine loop as mask image, do the following: Press the Stop button. Now you can scroll through the individual images of the cine loop with the help of the arrow buttons

181 13 Subtraction Modes Select the image you want to define as mask image with the arrow buttons and press the Mask button. Press the Play button. The cine loop is replayed. During cine playback, all images of the cine loop are subtracted from the defined mask image. To deactivate the mask image, do the following: Press the Mask off button. The cine loop is replayed without subtraction. The former mask image remains stored in the cine loop, only its mask function is deactivated Pixel shift Possible patient or C-arm movements between the acquisition of the mask image and the acquisition of the native image may lead to artifacts in the subtracted image. Using the pixel shift function, you can move the mask image and thus re-align the two images once again. Function You can use the pixel shift function in the following situations: After the acquisition of a DSA cine loop in the Subtraction operating mode During playback of a saved DSA cine loop in the Archive operating mode After the acquisition of an RSA image in the Subtraction operating mode As long as you have not saved the modified image yet, you can undo the mask image shift with the Home button. To correct artifacts in a subtracted image, do the following: Press the P-Sh button. Using the four arrow buttons, move the mask image pixel by pixel until it has reached the desired position. You can move the image by up to 8 pixels into each direction. Press the Save button. The corrected image is saved

182 13 Subtraction Modes 13.8 Landmarking Function With the landmarking function, you can superimpose a certain proportion of the mask image (70% max.) onto the subtracted image, thus providing anatomical landmarks for better orientation. You can use the landmarking function in the following situations: After the acquisition of a DSA cine loop in the Subtraction operating mode During playback of a saved DSA cine loop in the Archive operating mode After the acquisition of an RSA image in the Subtraction operating mode As long as you have not saved the modified image yet, you can undo the mask image overlay with the Home button. To overlay a certain proportion of the mask image onto the subtracted image (landmarking), do the following: Press the LM button. To increase the visible mask image amount in the subtracted image, press the Up Arrow button until reaching the desired level. To decrease the visible mask image amount in the subtracted image, press the Down Arrow button until reaching the desired level. Press the Save button. The image with the mask image overlay is saved

183 Post-Processing Images Overview Saved images can be post-processed at any time in the Post Process operating mode. Any adjustments which you make in the Post Process operating mode affect only the selected image (exception: monitor settings). General The following post-processing functions are available: Contrast/Brightness: Monitor settings Post-processing functions Contrast/Brightness: Contrast and brightness adjustment of individual images (windowing) Filter: Edge filter Zoom: To enlarge a selected image detail Grayscale Inversion: To display an image with negative grayscale Vertical Slot Collimator: Digital collimation (image crop) Horizontal Slot Collimator: Digital collimation (image crop) Reverse Up/Down: Vertical image reversal 14-1

184 14 Post-Processing Images Reverse Left/Right: Horizontal image reversal Image Rotation Text: Text functions ( Ch. 16, p. 16-1) Saving the changes Any modification is reflected immediately in the live monitor image. When you save an image, any modifications are saved as well and will be visible both when you re-open the image and in mosaic view. However, you can post-process an image as often as desired and also undo any changes you have made before. 14-2

185 14 Post-Processing Images 14.2 Activating the post-processing functions To activate an image for post-processing it, do the following: Locate the desired patient folder in the Archive operating mode and display it ( Ch , p ). Open the image you want to post-process. The selected image is displayed at full-screen size on the live monitor. Press the Post Proc. tab. The Post Process operating mode is activated. Fig Post Process operating mode Now you can post-process the selected image. You can browse through the active patient folder on the live monitor using the arrow buttons. In addition, you can mark and delete individual images. 14-3

186 14 Post-Processing Images 14.3 Contrast and brightness settings for the CRT monitors Function You can adjust the contrast and brightness of both monitors. These settings affect any image or thumbnail image mosaic displayed on the monitors and remain in force until you make new monitor settings or restart the system. The monitor settings are not saved together with the image. Initial settings You can preset the initial monitor settings which are valid after power-up of the system for both monitors in the Configuration operating mode under Monitor / Dose ( Ch. 20.4, p ). Fig Monitor settings and step windowing To adjust the contrast and brightness of both monitors, do the following: Press the Contrast/Brightness button. The monitor setting buttons are displayed in the dynamic control area. Fig Monitor setting and step windowing buttons 14-4

187 14 Post-Processing Images Use the arrow buttons to set the desired brightness and contrast. The new settings are reflected immediately on both monitors. If you want to restore the initial settings, press the Home button. Contrast and brightness are reset to the initial settings. Step windowing is reset to step 0. Press the Contrast/Brightness button. The monitor setting buttons disappear from the dynamic control area. The is equipped with an ambient light sensor. The sensor works automatically, so you do not need to activate it explicitly. The screen brightness is continuously readjusted to match any change in ambient light conditions during operation. The readjustment procedure is quite slow (up to 1 minute in duration) in order to suppress monitor flickering. Ambient light sensor Proper functioning of the ambient light sensor can be checked in the Configuration operating mode ( Ch. 20.4, p ) Contrast and brightness adjustment of individual images (windowing) The Windowing function allows you to adjust the contrast and brightness of the image on the live monitor. These settings affect only the selected image. If you save an image, the modified windowing values are saved as well, even if you have retrieved the image from the archive. Function After activating the windowing function, you can select a number of gray levels, which are then stretched over the entire range of 1024 gray levels of the original image on the live monitor. To achieve this effect, you adjust the width and the level of the so-called contrast window. The number of gray levels defines the width of the contrast window. The width of the contrast window affects the image contrast gray levels correspond to the value W 100 on the. The position of the selected gray levels on the original image grayscale (ranging from 0 to 1024 gray levels) defines the level of the contrast window. The level of the contrast window affects the image brightness. Example: You select all gray levels between 325 and 875. These gray levels are then mapped (stretched) to the range of 0 to 1024 gray levels in the processed image. This enhances the contrast. 14-5

188 14 Post-Processing Images Gray levels 0 to 324 of the original image are displayed as black, and gray levels 876 to 1024 of the original image are displayed as white. This means that the processed image is darker than the original image. There are two different windowing modes available: Standard windowing: The standard windowing mode allows you to freely choose the level and width of the contrast window. Step windowing: With step windowing, you choose between several predefined windowing steps. These windowing steps are preset and cannot be modified. The chosen windowing values are shown on the monitor as WX and LY. To set the brightness and contrast in standard windowing mode, do the following: Press the Contrast/Brightness button. The monitor setting buttons are displayed in the dynamic control area. Fig Monitor setting and step windowing buttons Press the WNDW button. The windowing setting buttons appear. Fig Buttons for standard windowing Under Width, set the number of gray levels using the arrow buttons. The chosen width is indicated by the length of the blue bar in the dynamic control area. The changes are reflected immediately in the image on the live monitor. Under Level, set the brightness range using the arrow buttons. 14-6

189 14 Post-Processing Images The chosen level is indicated by the position of the slider in the dynamic control area. The changes are reflected immediately in the image on the live monitor. If you want to restore the factory settings (level 50, width 100), press the Home button. To set the brightness and contrast with step windowing, do the following: Press the Contrast/Brightness button. The monitor setting buttons are displayed in the dynamic control area. Fig Monitor setting and step windowing buttons Select the desired windowing step using the arrow buttons. The settings are reflected immediately in the image on the live monitor. If you want to restore the factory settings for step windowing, press the Home button. Step windowing is reset to step 0. Simultaneously, brightness and contrast are reset to the initial settings. Press the Contrast/Brightness button. The monitor setting buttons disappear from the dynamic control area. 14-7

190 14 Post-Processing Images 14.5 Edge filter The edge filter allows you to select a greater or lesser degree of edge enhancement within the image. There are 4 levels available: Level Off Meaning No edge enhancement (original fluoroscopic image) 1 Slight edge enhancement 2 Medium edge enhancement 3 Strong edge enhancement -1 Unsharp mask to reduce noise Table 14-1 Edge filter levels To set the edge filter for the image, do the following: Press the Filter button. The edge filter setting buttons are displayed in the dynamic control area. Fig Edge filter settings Select the desired edge filter level by pressing the corresponding button. The filter acts on the live image on the live monitor. The chosen edge filter level is shown on the monitor as RTE X. Press the Filter button. The edge filter setting buttons disappear from the dynamic control area. 14-8

191 14 Post-Processing Images 14.6 Digital image zooming The zoom function allows you to enlarge a certain image detail. There are three zoom levels available. The desired image detail can be controlled either with the arrow buttons or with the integrated touchpad. Touchpad Fig Zoom function in the Post Process operating mode To enlarge an image detail, do the following: Press the Zoom button. The active image also appears on the reference monitor. The zoom function buttons are displayed in the dynamic control area. Fig Zoom function settings Select the desired zoom factor by pressing the corresponding button, e.g. 4 X. A marking circle appears in the center of the image on the live monitor. The image area within the marking circle is displayed on the reference monitor with the chosen zoom level. Move the marking circle to the desired image area using the arrow buttons. The chosen image detail is displayed on the reference monitor with the chosen zoom level. 14-9

192 14 Post-Processing Images If you want to move the marking circle back to the center of the live image, press the Home button. Press the Zoom button. The zoom function buttons disappear from the dynamic control area. To enlarge an image detail with the help of the touchpad, do the following: Press the Zoom button. The active image also appears on the reference monitor. The zoom function buttons are displayed in the dynamic control area. Fig Zoom function settings Select the desired zoom factor by pressing the corresponding button, e.g. 4 X. A marking circle appears in the center of the image on the live monitor. The image area within the marking circle is displayed on the reference monitor with the chosen zoom level. Move the marking circle to the desired position by gliding your finger slightly across the touchpad. The chosen image detail is displayed on the reference monitor with the chosen zoom level. If you want to move the marking circle back to the center of the live image, press the Home button. Press the Zoom button. The zoom function buttons disappear from the dynamic control area

193 14 Post-Processing Images 14.7 Grayscale inversion The grayscale inversion function allows you to represent the active image with a negative grayscale. Function To represent an image with a negative (or positive) grayscale, do the following: Press the Grayscale Inversion button. The image is represented with negative grayscale on the live monitor. Press the Grayscale Inversion button again. The image is again represented with a positive grayscale Image rotation Press the Rotate Image CW button until the desired setting becomes visible on the live monitor. The image is rotated steplessly in clockwise direction. Press the Rotate Image CCW button until the desired setting becomes visible on the live monitor. The image is rotated steplessly in counter-clockwise direction. The chosen angle of rotation is shown on the monitor as RX. As soon as an image is rotated, it assumes a circular shape. The image has a square shape only in the following angle positions: 0 /360, 90, 180, 270. FD 14.9 Horizontal and vertical image reversal Press the Reverse Up/Down button. On the live monitor, the image appears with top and bottom reversed, and a symbol for up/down reversal is displayed. Press the Reverse Left/Right button. On the live monitor, the image appears with left and right side reversed, and a symbol for left/right reversal is displayed

194 14 Post-Processing Images Image reversal is symbolized on the monitor by an R which is either mirrored left-right or upside-down Digital collimation (image crop) Press the Close Vertical Slot Collimator button until the desired setting becomes visible on the live monitor. The vertical slot collimator closes steplessly. Press the Open Vertical Slot Collimator button until the desired setting becomes visible on the live monitor. The vertical slot collimator opens steplessly. Press the Close Horizontal Slot Collimator button until the desired setting becomes visible on the live monitor. The horizontal slot collimator closes steplessly. Press the Open Horizontal Slot Collimator button until the desired setting becomes visible on the live monitor. The horizontal slot collimator opens steplessly Marking and deleting images Browsing through the patient folder You can browse through an active patient folder in the Post Process operating mode without having to switch to the Archive operating mode. The live monitor always shows the selected image at full-screen size. Marking To mark one or more images, do the following: Select the desired image on the live monitor using the arrow buttons. Press the Mark button. The image is now marked and receives the label M. If you want to mark further images in addition, repeat the procedure

195 14 Post-Processing Images To unmark an image, do the following: Select the desired marked image on the live monitor using the arrow buttons. Press the Mark button. The image becomes unmarked. To protect one or more images, do the following: Select the desired image on the live monitor using the arrow buttons. Protecting Press the Protect button. The image is now protected and receives the label P. If you want to protect further images, repeat the procedure. To unprotect an image, do the following: Select the desired protected image using the arrow buttons. Press the Protect button. The image becomes unprotected. Note Patient folders containing protected images cannot be deleted automatically. If many folders on the hard disk contain protected images, the auto-delete function ( p. 8-11) may not be working properly, and you will be unable to save new images. To avoid this situation, regularly back up the patient folders which are still needed to external storage media or to a DICOM server. You can then manually delete those patient folders or unprotect them and allow the auto-delete function to free up space on your hard disk

196 14 Post-Processing Images To delete one or more images from a patient folder, do the following: CAUTION Deleted images are irretrievably lost. Back up the images you want to delete or make sure that they are really no longer needed. Mark the images you want to delete and press the Delete Marked Items button. The following confirmation prompt is displayed: or or Mark the images you do not want to delete and press the Delete Unmarked Items button. The following confirmation prompt is displayed: or or Select the individual image you want to delete using the arrow buttons. Press the Delete button. The following confirmation prompt is displayed: 14-14

197 14 Post-Processing Images Confirm by pressing the Yes button. The images are deleted from the patient folder Outputting images You can save individual images to hard disk ( Ch. 8.7, p. 8-10) or floppy disk or print them on the video printer in the Post Process operating mode as well. These actions are always applied to the selected image or to the marked images. Output options When you save an image, the changes applied to it are saved as well and will be visible the next time you open the image. However, you can postprocess an image as often as desired and also undo any changes you have made before. You can save images to floppy disk in 8 bit BMP format only. A 3.5" high-density floppy disk (1.44 MB) stores one image. The floppy disk must have been preformatted on an external MS DOS compatible PC. The floppy disk drive which is mounted in the system does not support formatting. Saving to floppy disk To save an image to floppy disk, do the following: Mark the image you want to save. Insert a formatted floppy disk into the floppy disk drive mounted in the monitor cart. Press the Floppy Disk button. The marked image is saved to the floppy disk. A progress indicator in a message window on the control panel informs you about the status of the save operation. Once it has been saved, the image becomes unmarked

198 14 Post-Processing Images To print images on the video printer, do the following: Select the image you want to print. or or Mark the images you want to print. Press the Print button. The marked images are printed on the video printer mounted in the monitor cart. A progress indicator in a message window on the control panel informs you about the status of the print operation. Once they have been printed, the images become unmarked

199 Measurements Measuring functions The lets you measure various distances and angles in a saved fluoroscopic image. You can use the same measuring method several times in an image. General Fig Measurement operating mode The following functions are available for that purpose: Calibration: To have an absolute scale for measurements, you must acquire the length of a reference object prior to each measurement. Length or distance (2-Point): Measures the length of a line. 3-point measurement (3-Point): Measures the lengths of two contiguous lines and the interior angle between them. In addition, the angle difference to a full circle is calculated. 4-point measurement (4-Point): Measures the lengths of two noncontiguous lines and the angle between them. In addition, the angle difference to 180 is calculated. 15-1

200 15 Measurements 4-point ratio measurement (4-Point Ratio) Computes the length ratio between two lines. All measurements you perform in a fluoroscopic image are shown simultaneously in the image. The measuring points are identified by capital letters which are assigned in alphabetic order. This means that the designation of the measuring points may vary, depending on the order in which you perform the different measurements. Measuring inaccuracy The larger the distance between the object of measurement and the image intensifier, the more inaccurate the measurement will be. Therefore position the object of measurement as closely as possible to the image intensifier or use the electronic magnification function, especially if the object of measurement is very small. The measuring resolution on the screen is 512 pixels. With a 31 cm i.i., this results in a pixel distance of 310/512 = 0.6 mm in relation to the object of measurement. Zoom function If you change the zoom factor ( Ch. 14.6, p. 14-9) after making a measurement, the measured values will no longer be correct. In this case, the following message will be displayed on the control panel: Measurement invalid due to zoom factor change. Thumbnail mosaic The measurements that you have performed on an image are not visible in the thumbnail mosaic view. Cine loop When you perform a measurement on a cine loop image and save it, this measurement is saved for all images of the cine loop and visible in all cine loop images. 15-2

201 15 Measurements 15.2 Calibrating To have an absolute scale for a measurement, you must first acquire a reference length. For that purpose, you must screen a reference object of a known length or distance (e.g. a ruler or a balloon catheter with radiopaque markers). Then you mark the known distance or length in the fluoroscopic image and enter the corresponding value manually. Point A Point B Fig Calibrating Measurements on a fluoroscopic image will only provide accurate results if, during the acquisition of the relevant calibration image, the reference object has been placed in exactly the same plane as the object to be measured later. Validity of the calibration If the position of the patient or the C-arm is changed after the calibration, you must repeat the calibration before performing a new measurement. To perform a calibration, do the following: The measuring points may have different designations, depending on the order in which the measurements are performed ( p. 15-2). In the following procedure, the measuring points are designated as A and B by way of example. Designation of the measuring points Screen the reference object in the Fluoroscopy operating mode. The reference object must be in the same plane as the object you want to measure. The image is displayed on the live monitor. Press the Measure tab. The Measurement operating mode is activated. Press the Calibration button. 15-3

202 15 Measurements The buttons and boxes for the calibration function are displayed in the dynamic control area. Fig Calibration function Two white marker squares appear in the fluoroscopic image on the live monitor; they mark the exact measuring points. The measuring points are called A and B, and the marker square next to point A is highlighted by a double frame. The two marker squares are connected by a line. This line symbolizes the reference length which is to be determined. Move marker square A with the four arrow buttons to the desired first measuring point on the reference object, e.g. the first radiopaque marker on a balloon catheter. Press the Next Measuring Point button. Marker square B is now highlighted by a double frame. Move the second marker square with the four arrow buttons to the desired second measuring point on the reference object, e.g. the second radiopaque marker on a balloon catheter. Enter the length of the reference object in the Reference Length input box. Press the Enter button. If you wish to modify the length you have entered, press the Delete button and enter another value. Press the OK button. The acquired and saved calibration value remains in force until you switch off the system. 15-4

203 15 Measurements 15.3 Measuring a length or distance This function measures the distance between any two points defined by you. Point A Point B Fig Distance measurement To be able to measure a length or distance, you must perform a calibration first ( Ch. 15.2, p. 15-3). The calibration value remains in force until you switch off the system. Prerequisite To measure a length or distance, do the following: The measuring points may have different designations, depending on the order in which the measurements are performed ( p. 15-2). In the following procedure, the measuring points are designated as A and B by way of example. Designation of the measuring points Open the desired image in the Archive operating mode ( Ch. 10.3, p. 10-7). Press the Measure tab. The Measurement operating mode is activated. The selected image is displayed at full-screen size on the live monitor. Press the 2-Point button. Note If the 2-Point button is unavailable, you must perform a calibration first. The buttons for controlling the length or distance function are displayed in the dynamic control area. 15-5

204 15 Measurements Fig Length or distance function Two white marker squares appear in the fluoroscopic image on the live monitor; they mark the exact measuring points. The measuring points are called A and B, and the marker square next to point A is highlighted by a double frame. The two marker squares are connected by a line. This line symbolizes the length or distance which is to be determined. Move marker square A to the starting point of the desired line using the four arrow buttons. The Reference Length read-only box shows the reference length which was entered during calibration. The Length 1 read-only box shows the current length of the distance. When the marker square has reached the desired starting point, press the Next Measuring Point button. Marker square B is now highlighted by a double frame. Move the second marker square to the final point of the desired length or distance using the four arrow buttons. The current length of the distance is indicated in the Length 1 readonly box on the control panel. The value is immediately adjusted as soon as you change the position of one of the two measuring points. If you want to change the position of a measuring point, press the Next Measuring Point button until the desired marker square starts flashing, and then move it to the desired new position. The length of the modified distance is indicated in the Length 1 readonly box on the control panel. Press the OK button. Press the Save button. The image with the measurement is saved. 15-6

205 15 Measurements You can edit any distance or length measurement as long as the patient folder containing the image with the respective measurement is active. Editing a distance or length measurement Note You cannot edit any distance/length measurements in images that have been retrieved from the archive. The arrow buttons are unavailable. However, you can delete existing length or distance measurements and make new ones. To edit a distance or length measurement, do the following: Press the Edit button. The marker square is on one of the measuring points. Press the Next Measuring Point button until the marker square is on the measuring point whose position you want to change. Move the marker square to the desired position using the arrow buttons. Press the OK button. Press the Save button. You can repeat this procedure as often as you want as long as the patient folder is active. To delete a length or distance measurement, do the following: Press the Delete button. The measured length or distance is deleted. To jump from one measurement to the next one, do the following: Press the Edit button. The marker square is on one of the measuring points of the first measurement. Press the Edit button. The marker square jumps to one of the measuring points of the next measurement. Repeat these two steps until the marker square has reached one of the measuring points of the desired measurement. 15-7

206 15 Measurements point measurement A 3-point measurement determines the lengths of two contiguous lines, the angle between them and the angle difference to a full circle. 360 Angle Point B Angle Point A Point C Fig point measurement Prerequisite To be able to measure a length or distance, you must perform a calibration first ( Ch. 15.2, p. 15-3). The calibration value remains in force until you switch off the system. To perform a 3-point measurement, do the following: Designation of the measuring points The measuring points may have different designations, depending on the order in which the measurements are performed ( p. 15-2). In the following procedure, the measuring points are designated as A, B and C by way of example. Open the desired image in the Archive operating mode ( Ch. 10.3, p. 10-7). Press the Measure tab. The Measurement operating mode is activated. The selected image is displayed at full-screen size on the live monitor. Press the 3-Point button. Note If the 3-Point button is unavailable, you must perform a calibration first. The buttons for controlling the 3-point measurement function are displayed in the dynamic control area. 15-8

207 15 Measurements Fig point measurement function Three white marker squares appear in the fluoroscopic image on the live monitor; they mark the exact measuring points. The measuring points are called A, B and C, and the marker square next to point A is highlighted by a double frame. Move the marker square to the desired point A using the four arrow buttons. Press the Next Measuring Point button. Marker square B is now highlighted by a double frame. The Reference Length read-only box shows the reference length which was entered during calibration. The current length and angle values are displayed together with their designations in the Length 1 (distance 1), Length 2 (distance 2), Angle (interior angle) and 360 Angle (angle difference to a full circle) read-only boxes. The values are immediately adjusted as soon as you change the position of one of the measuring points. Move the second marker square to the desired point B using the four arrow buttons. Press the Next Measuring Point button. Marker square C is now highlighted by a double frame. Move the third marker square to the desired point C using the four arrow buttons. If you want to change the position of a measuring point, press the Next Measuring Point button until the desired marker square starts flashing, and then move it to the desired new position. The new values of the modified distances are indicated in the respective boxes on the control panel. 15-9

208 15 Measurements Press the OK button. Press the Save button. The image with the measurement is saved. Editing a 3-point measurement You can edit any 3-point measurement as long as the patient folder containing the image with the respective measurement is active. Note You cannot edit any 3-point measurements in images that have been retrieved from the archive. The arrow buttons are unavailable. However, you can delete existing 3-point measurements and make new ones. To edit a 3-point measurement, do the following: Press the Edit button. The marker square is on one of the measuring points. Press the Next Measuring Point button until the marker square is on the measuring point whose position you want to change. Move the marker square to the desired position using the arrow buttons. Press the OK button. Press the Save button. You can repeat this procedure as often as you want as long as the patient folder is active. To delete a 3-point measurement, do the following: Press the Delete button. The 3-point measurement is deleted. To jump from one measurement to the next one, do the following: Press the Edit button. The marker square is on one of the measuring points of the first measurement

209 15 Measurements Press the Edit button. The marker square jumps to one of the measuring points of the next measurement. Repeat these two steps until the marker square has reached one of the measuring points of the desired measurement point measurement A 4-point measurement determines the lengths of two noncontiguous lines, the angle between them and the angle difference to Angle Point B Angle Point C Point A Point D Fig point measurement To be able to measure a length or distance, you must perform a calibration first ( Ch. 15.2, p. 15-3). The calibration value remains in force until you switch off the system. Prerequisite To perform a 4-point measurement, do the following: The measuring points may have different designations, depending on the order in which the measurements are performed ( p. 15-2). In the following procedure, the measuring points are designated as A, B,C and D by way of example. Designation of the measuring points Open the desired image in the Archive operating mode ( Ch. 10.3, p. 10-7). Press the Measure tab. The Measurement operating mode is activated. The selected image is displayed at full-screen size on the live monitor. Press the 4-Point button

210 15 Measurements Note If the 4-Point button is unavailable, you must perform a calibration first. The buttons for controlling the 4-point measurement function are displayed in the dynamic control area. Fig point measurement function Four white marker squares appear in the fluoroscopic image on the live monitor; they mark the exact measuring points. The measuring points are called A, B, C and D, and the marker square next to point A is highlighted by a double frame. Move the marker square to the desired point A using the four arrow buttons. Press the Next Measuring Point button. Marker square B is now highlighted by a double frame. The Reference Length read-only box shows the reference length which was entered during calibration. The current length and angle values are displayed together with their designations in the Length 1 (distance 1), Length 2 (distance 2), Angle (interior angle) and 180 Angle read-only boxes. The values are immediately adjusted as soon as you change the position of one of the measuring points. Move the second marker square to the desired point B using the four arrow buttons. Press the Next Measuring Point button. Marker square C is now highlighted by a double frame. Move the third marker square to the desired point C using the four arrow buttons

211 15 Measurements Press the Next Measuring Point button. Marker square D is now highlighted by a double frame. Move the marker square to the desired point D using the four arrow buttons. If you want to change the position of a measuring point, press the Next Measuring Point button until the desired marker square starts flashing, and then move it to the desired new position. The new values of the modified distances are indicated in the respective boxes on the control panel. Press the OK button. Press the Save button. The image with the measurement is saved. You can edit any 4-point measurement as long as the patient folder containing the image with the respective measurement is active. Editing a 4-point measurement Note You cannot edit any 4-point measurements in images that have been retrieved from the archive. The arrow buttons are unavailable. However, you can delete existing 4-point measurements and make new ones. To edit a 4-point measurement, do the following: Press the Edit button. The marker square is on one of the measuring points. Press the Next Measuring Point button until the marker square is on the measuring point whose position you want to change. Move the marker square to the desired position using the arrow buttons. Press the OK button

212 15 Measurements Press the Save button. You can repeat this procedure as often as you want as long as the patient folder is active. To delete a 4-point measurement, do the following: Press the Delete button. The 4-point measurement is deleted. To jump from one measurement to the next one, do the following: Press the Edit button. The marker square is on one of the measuring points of the first measurement. Press the Edit button. The marker square jumps to one of the measuring points of the next measurement. Repeat these two steps until the marker square has reached one of the measuring points of the desired measurement

213 15 Measurements point ratio measurement A 4-point ratio measurement determines the lengths of two noncontiguous lines and their length ratio. Point B Point C Point A Point D Fig point ratio measurement To be able to measure a length or distance, you must perform a calibration first ( Ch. 15.2, p. 15-3). The calibration value remains in force until you switch off the system. Prerequisite To perform a 4-point ratio measurement, do the following: The measuring points may have different designations, depending on the order in which the measurements are performed ( p. 15-2). In the following procedure, the measuring points are designated as A, B,C and D by way of example. Designation of the measuring points Open the desired image in the Archive operating mode ( Ch. 10.3, p. 10-7). Press the Measure tab. The Measurement operating mode is activated. The selected image is displayed at full-screen size on the live monitor. Press the 4-Point Ratio button. Note If the 4-Point Ratio button is unavailable, you must perform a calibration first. The buttons for controlling the 4-point ratio measurement function are displayed in the dynamic control area

214 15 Measurements Fig point ratio measurement function Four white marker squares appear in the fluoroscopic image on the live monitor; they mark the exact measuring points. The measuring points are called A, B, C and D, and the marker square next to point A is highlighted by a double frame. Move the marker square to the desired point A using the four arrow buttons. Press the Next Measuring Point button. Marker square B is now highlighted by a double frame. The Reference Length read-only box shows the reference length which was entered during calibration. The current length and length ratio values are displayed in the Length 1 (distance 1), Length 2 (distance 2) and Length 1 / Length 2 (length ratio) read-only boxes. The values are immediately adjusted as soon as you change the position of one of the measuring points. Move the second marker square to the desired point B using the four arrow buttons. Press the Next Measuring Point button. Marker square C is now highlighted by a double frame. Move the third marker square to the desired point C using the four arrow buttons. Press the Next Measuring Point button. Marker square D is now highlighted by a double frame. Move the marker square to the desired point D using the four arrow buttons

215 15 Measurements If you want to change the position of a measuring point, press the Next Measuring Point button until the desired marker square starts flashing, and then move it to the desired new position. The new values of the modified distances are indicated in the respective boxes on the control panel. Press the OK button. Press the Save button. The image with the measurement is saved. You can edit any 4-point ratio measurement as long as the patient folder containing the image with the respective measurement is active. Editing a 4-point ratio measurement Note You cannot edit any 4-point ratio measurements in images that have been retrieved from the archive. The arrow buttons are unavailable. However, you can delete existing 4-point ratio measurements and make new ones. To edit a 4-point ratio measurement, do the following: Press the Edit button. The marker square is on one of the measuring points. Press the Next Measuring Point button until the marker square is on the measuring point whose position you want to change. Move the marker square to the desired position using the arrow buttons. Press the OK button. Press the Save button. You can repeat this procedure as often as you want as long as the patient folder is active. To delete a 4-point ratio measurement, do the following: Press the Delete button. The 4-point ratio measurement is deleted

216 15 Measurements To jump from one measurement to the next one, do the following: Press the Edit button. The marker square is on one of the measuring points of the first measurement. Press the Edit button. The marker square jumps to one of the measuring points of the next measurement. Repeat these two steps until the marker square has reached one of the measuring points of the desired measurement

217 Displayed Texts and Text Functions Overview On a, the image always has a circular shape. On a Ziehm Vision FD, the image normally has a square shape. As soon as an image is rotated on a FD, it assumes a circular shape. The image has a square shape only in the following angle positions: 0 /360, 90, 180, 270. Shape of displayed image Some image information is always displayed automatically as text on the monitor. Detailed patient and image data can be found on the control panel ( Ch. 10.3, p. 10-7). In addition, you may enter your own text or markers directly onto the fluoroscopic image in a text annotation area on the monitor and save a note together with the image. Image information 16.2 Image information on the monitor Upper left corner of the monitor In this area, the last name, first name, patient ID and date of birth of the patient are displayed. Patient data is entered or corrected in the Patient operating mode ( Ch. 10.2, p. 10-2). Patient data Upper right corner of the monitor In this area, the name of the hospital, the attending physician and department are displayed. The hospital data can be entered in the Configuration operating mode under Basic Settings ( Ch , p ) and may have been corrected later in the Patient operating mode, if necessary ( Ch , p. 10-3). Hospital data As soon as you have saved an image, its image number is displayed ( Ch. 8.7, p. 8-10). For marked or protected images, the label M or P is displayed directly behind the image number. Image number and label 16-1

218 16 Displayed Texts and Text Functions DICOM status If the image has already been transferred to a DICOM server ( Ch , p. 11-9) or imported from a DICOM server into the Ziehm Vision ( Ch. 11.5, p ), a label saying DICOM X is displayed: DICOM D: The image has been transferred successfully to the DICOM server DICOM C: The image has been transferred successfully to the DICOM server and stored safely (Storage Commitment) DICOM R: The image has been imported from the DICOM server into the Image type If a cine loop, DSA, MSA or RSA image is displayed, a corresponding label (CINE, DSA, MSA, RSA) shows up Lower left corner of the monitor Image reversal Image reversal is symbolized on the monitor by an R which is either mirrored upside-down or left-right. This symbol appears in the following cases: The live image is reversed ( Ch , p. 9-16). An image which has been saved with reversal is displayed ( Ch. 14.9, p ). Recursive filter The chosen recursive filter level ( Ch , p. 9-7) is shown as NR X. Edge filter The chosen edge filter level ( Ch , p. 9-8 or Ch. 14.5, p. 14-8) is shown as RTE X. Stack filter The chosen stack filter level ( Ch , p. 9-9) is shown as LIH X. Angle of rotation The angle of rotation which has been chosen for the image ( Ch , p or Ch. 14.8, p ) is shown as R X. Windowing values The chosen windowing values ( Ch. 9.3, p. 9-4 or Ch. 14.4, p. 14-5) are shown as W X and L Y. Time and date of saving The time and date of saving are automatically assigned by the system and cannot be edited. 16-2

219 16 Displayed Texts and Text Functions Lower right corner of the monitor The following fluoroscopy parameters are displayed here: Tube voltage in kv Tube current in ma Dose area product in cgy cm 2 Total radiation time accumulated until now for the active patient folder in seconds ( Ch. 8.6, p. 8-10) The values are automatically assigned by the system and cannot be edited. Fluoroscopy parameters Furthermore, the image magnification level chosen for the image is shown as MAG X. Image magnification level Below the fluoroscopy parameters, an abbreviation indicates which anatomical program was used for generating the image: Anatomical program Abbreviation BONE HRT ABD SOFT DSA MSA RSA Anatomical program Bones Heart Abdomen Soft DSA MSA RSA Table 16-1 Abbreviations for anatomical programs 16-3

220 16 Displayed Texts and Text Functions 16.3 Entering and editing text Activating the Text operating mode You can activate the Text operating mode from the following operating modes: Fluoroscopy Subtraction Post Process Measurements Simply press the Text button in the corresponding operating mode. The Text operating mode is activated. Fig Text operating mode You may add the following elements to a fluoroscopic image on the live monitor: Any desired text An arrow in various sizes pointing to different directions The markers L or R in various sizes The arrow and the marking letters are available in three sizes (large, medium, small). The chosen size is indicated in the center of the arrow block. The default size is always large. The size can be modified with the Size button. 16-4

221 16 Displayed Texts and Text Functions Fig Arrow block and size indication The texts, markers or arrows that you have added to the image are not visible in the thumbnail mosaic view. Thumbnail mosaic In the Text operating mode, you may furthermore enter a note on the current image. This note is displayed in the Archive operating mode together with the image information ( Fig. 10-6, p ). Note To add a text to the fluoroscopic image, do the following: Press the Text button. The cursor on the control panel jumps to the text input box. Enter the desired text using the alphanumeric keypad which is displayed on the control panel. Note To type an uppercase letter, press and release the Shift key before entering the respective letter. The Shift key is valid for one subsequent letter. If you want to type several consecutive uppercase letters, press the Caps Lock key before entering the letters. The text appears both in the input box on the control panel and in the fluoroscopic image on the monitor. The text in the fluoroscopic image is surrounded by a marker frame. Move the text to the desired position using the arrow buttons. If you want to undo an input, press the Cancel button. The text and its position are deleted. or or If you want to confirm your input, press the OK button. The marker frame disappears. The text input box on the control panel is cleared. Press the Save button. 16-5

222 16 Displayed Texts and Text Functions Press the Back button. The previously active operating mode is reactivated. or To add a marker to the fluoroscopic image, do the following: Select the arrow or the marking letter you want to insert by pressing the corresponding button. The arrow or the marking letter appear in the fluoroscopic image on the monitor. Move the arrow or marking letter to the desired position using the arrow buttons. Press the Size button until the desired size has been reached. The chosen size (large, medium, small) is indicated in the center of the arrow block. If you want to undo an input, press the Cancel button. The arrow or marking letter and its position are deleted. or If you want to confirm your input, press the OK button. Press the Save button. Press the Back button. The previously active operating mode is reactivated. To edit a text annotation, do the following: Press the Edit button until the cursor on the monitor jumps to the annotation you want to edit. Enter the new text using the alphanumeric keypad. To delete a text annotation, do the following: Press the Edit button until the cursor on the monitor jumps to the annotation you want to delete. Press the Delete button. To edit a marker, do the following: Press the Edit button until the cursor on the monitor jumps to the marker you want to edit. Make the desired changes. 16-6

223 16 Displayed Texts and Text Functions To delete a marker, do the following: Press the Edit button until the cursor on the monitor jumps to the marker you want to delete. Press the Delete button. To enter a note on an image, do the following: Press the Note button. The cursor on the control panel jumps to the note input box. Enter the desired note using the alphanumeric keypad which is displayed on the control panel. Note To type an uppercase letter, press and release the Shift key before entering the respective letter. The Shift key is valid for one subsequent letter. If you want to type several consecutive uppercase letters, press the Caps Lock key before entering the letters. Press the Save button. 16-7

224 16 Displayed Texts and Text Functions 16-8

225 Image Documentation Overview Optionally, different image documentation systems can be incorporated into the monitor cart. The following systems are available: Video printer Video cassette recorder Up to 2 of these systems can be accommodated in the mounting frame below the control panel. The following documentation options are available in addition: Storage media: CD or DVD ( p ), USB storage device ( p ), floppy disk ( p ) DICOM interface ( p. 11-1) 17.2 Output to video printer The print live monitor image function is available in the following operating modes: Fluoroscopy, Subtraction, Post Process, Measurement and Archive. This function is only enabled if the monitor cart is equipped with a video printer. The function always prints out the image which is displayed at full-screen size on the live monitor. To print out the image on the live monitor on the video printer, do the following: Press the Print Live Monitor Image button. The text information that is displayed on the monitor together with the image (name of the patient, angle of rotation of the image, etc.) will appear as a text block on a gray background at the left margin of the printout. If you have performed measurements in an image and saved them subsequently, the measured values are printed on a second page. Note When you launch the print job directly from the video printer, the resulting hard copy will be an exact reproduction of the live monitor. 17-1

226 17 Image Documentation Further information For further information, please refer to the video printer s separate operating instructions provided with this system Record and playback on video cassette recorder The VCR button is displayed on the control panel only if the monitor cart is equipped with a video cassette recorder. The video cassette recorder is controlled using buttons that appear on the control panel. Fig Buttons for controlling the video cassette recorder Automatic recording If you have activated the Automatic Recording function, video recording starts automatically as soon as you release radiation. If you have not activated the Automatic Recording function, you must start video recording with the buttons on the control panel. To activate the Automatic Recording function, do the following: Press the VCR button. The buttons for controlling the video cassette recorder are displayed in the dynamic control area. Press the Automatic Recording option. The check box receives a check mark. The Automatic Recording function is active now. To record fluoroscopic images to video tape, do the following: Insert a video tape into the video cassette recorder. Press the VCR button. The buttons for controlling the video cassette recorder are displayed in the dynamic control area. Press the REC button on the control panel. The REC+Play+PAUSE buttons are active now. 17-2

227 17 Image Documentation If you have activated the Automatic Recording function: Initiate radiation. The PAUSE button is automatically deactivated and the fluoroscopic images are recorded on the video tape. or or If you have not activated the Automatic Recording function: Press the PAUSE button. The fluoroscopic images are recorded on the video tape. Terminate radiation. or Press the PAUSE button. Video recording stops. You can replay the recorded images using the integrated video cassette recorder. The images are displayed on the live monitor. Playback To replay the fluoroscopic images on the video cassette recorder, do the following: Insert the video tape into the video cassette recorder. Press the VCR button. The buttons for controlling the video cassette recorder are displayed in the dynamic control area. Press the Play button on the control panel. The fluoroscopic images are displayed one after the other on the live monitor. Press the PAUSE button. A still image is displayed on the live monitor. The video image is available at the video output socket for further processing. For further information, please refer to the video cassette recorder s separate operating instructions supplied with this system. Further information 17-3

228 17 Image Documentation 17-4

229 Laser Positioning Device 18 As an option, the system may be equipped with a laser positioning device at the image intensifier and/or generator. The laser positioning device uses diode laser modules which emit laser radiation. Do not under any circumstances look directly at the laser beam or any scattered laser radiation either with the naked eye or with optical instruments. The laser positioning device is a Class 2M laser product according to IEC : Make sure to comply with all operating safety precautions when using the laser positioning device. The maximum output of continuous laser radiation, measured at the beam exit, is <1 mw. The wavelength of the emitted radiation is 635 nm. The laser positioning device generates a laser-beam crosshair, the central point of which marks the position of the central X-ray beam on the patient. For safety, the laser positioning device is switched off automatically after 1 minute. WARNING LASER RADIATION DO NOT LOOK INTO THE BEAM! Do not look directly with optical instruments into the laser beam apertures, since doing so can be hazardous to your eyes! Laser Class II in accordance with FDA 21 CFR, Subchapter J, section Please observe the provisions of IEC :2001, Section 3, User s Guide for operation of the laser positioning device Applications You can use the laser positioning device for the following tasks: As alignment aid for positioning the C-arm For foreign body localization As a navigational aid for nail fixations 18-1

230 18 Laser Positioning Device Positioning aid The laser positioning device allows you to position the C-arm exactly above the patient without having to initiate radiation: Press the Laser button. A laser-beam crosshair is generated, the central point of which corresponds to the position of the central X-ray beam. Position the C-arm in such a way above the patient that the central point of the laser-beam crosshair is exactly in the center of the region to be screened. Initiate radiation. Foreign body localization You can use the laser positioning device also for foreign body localization: For that purpose, you must activate the on-screen crosshair on the monitor first ( Ch , p. 20-4). To localize a foreign body with the help of the laser positioning device, do the following: Initiate radiation. The foreign body becomes visible in the image on the live monitor. Position the C-arm in such a way above the patient that the center of the crosshair on the screen lies exactly over the foreign body in the fluoroscopic image. Press the Laser button. The laser positioning device s laser-beam crosshair now marks the patient s skin exactly above the point where the foreign body lies, thus allowing a precise determination of the point of surgical incision. 18-2

231 Direct Radiography Overview The can also be used for making direct radiographic film exposures. This option is not available for the FD. Direct radiographies are only possible if your system is equipped with a film cassette holder (optional accessory) Fitting the film cassette holder To fit the film cassette holder for direct radiographic exposures onto the image intensifier, do the following: Pull the spring-loaded securing lever on the film cassette holder outward. Slide the film cassette holder over the supporting ridge on the image intensifier. Release the spring-loaded securing lever. The securing lever engages above the supporting ridge. Insert a loaded film cassette fully into the film cassette holder from the side. Image intensifier Securing lever Film cassette holder Film cassette Fig Fitting the film cassette holder and inserting the film cassette 19-1

232 19 Direct Radiography 19.3 Making a direct radiographic exposure For direct radiography, you can set the following maximum collimator apertures for the film or cassette size used: 31 cm image intensifier (not available in the U.S.A.): 24 cm 30 cm; the visible image has a diameter of max. 27 cm 23 cm image intensifier: 24 cm; the visible image has a diameter of 23 cm WARNING Make sure that the selected collimator aperture does not exceed the cassette size used. Manual settings For tube voltage, use the value that the system has automatically selected during the previous fluoroscopy. If necessary, you can correct this value manually. The mas value (tube current in ma time in seconds) is always set manually. The tube current ranges from 15 ma to 20 ma. The system automatically adjusts this value to reach the manually set value. The exposure time is also computed automatically from the manually set value and appears rounded to the first digit after the decimal point on the display. To make a direct radiographic exposure, do the following: WARNING Make sure that the film cassette holder is properly attached to the image intensifier, so that the cassette cannot fall down onto the patient! Press the Radiography tab. The Radiography operating mode is activated. The buttons for controlling the direct radiography functions are displayed in the dynamic control area. 19-2

233 19 Direct Radiography Fig Radiography operating mode (film size 30 cm is not available in the U.S.A.) Select the desired film size (e.g. 24 cm) by pressing the button with the same label. In the U.S.A., only the film size 24 cm is available. Set the desired tube voltage value using the arrow buttons. The selected value appears on the Voltage display. Set the desired tube current time (mas) value using the arrow buttons. The selected value appears on the mas display. Initiate radiation using the hand switch. In the Radiography operating mode, you cannot initiate radiation with the foot switch. An audible alarm will sound throughout the entire exposure time. Radiation is terminated automatically after the preset exposure time. You can interrupt the exposure before the selected exposure time has elapsed by releasing the hand switch. Withdraw the film cassette. Remove the film cassette holder from the image intensifier. 19-3

234 19 Direct Radiography 19-4

235 System Configuration Overview In the Configuration operating mode, you can make a wide variety of presettings. The following setting options are available for that purpose: Operation settings Basic settings Defining the initial settings for the monitors, checking the sensor and the dose meter (Monitor / Dose) Managing storage media (Storage Media) General The Vision Center control panel on the C-arm stand also provides access to the Service Settings. This access is password-protected. Consequently, the following settings and/or actions can and must be made by a service engineer only: Settings for anatomical programs DICOM settings Collimator adjustments Uploading machine data to floppy disk Service settings 20-1

236 20 System Configuration 20.2 Operation settings Function Under Operation Settings you define the settings which determine the operational conditions during fluoroscopy. Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. Fig Configuration operating mode Autotransfer Moving the fluoroscopic image Under Autotransfer you activate or deactivate the Autotransfer function (automatic image swapping). Fig Autotransfer Autotransfer activated: When you initiate radiation, the fluoroscopic image on the live monitor is moved automatically to the reference monitor. 20-2

237 20 System Configuration Autotransfer deactivated: When you initiate radiation, the fluoroscopic image on the live monitor is automatically deleted. When you switch on the system, the Autotransfer function is deactivated by default. If you activate the Autotransfer function during operation, it will be deactivated automatically when you switch off the system. To activate the Autotransfer function, do the following: Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. Press the Autotransfer option. The check box receives a check mark. Press the Apply button. The Autotransfer function remains active until you switch off the system Autostore Under Autostore you activate or deactivate the autostore (automatic saving) function. Fig Autostore Autostore activated: During each fluoroscopy, a new image will be saved automatically as soon as you terminate radiation. Autostore deactivated: The system does not save the images automatically. You must save the desired fluoroscopic images manually ( p. 8-10). When you switch on the system, the autostore function is deactivated by default. If you activate the autostore function during operation, it will be deactivated automatically when you switch off the system. Alternatively, you can activate the autostore function by means of the Save button ( p. 8-11). 20-3

238 20 System Configuration To activate the autostore function, do the following: Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. Press the Autostore option. The check box receives a check mark. Press the Apply button. The autostore function remains active until you switch off the system Displaying a crosshair Positioning aid Under Crosshair you determine whether a crosshair is displayed as positioning aid (e.g. for foreign body localization, see Ch. 18.1, p. 18-1) in the image on the live monitor during fluoroscopy. The central point of the crosshair corresponds to the position of the central X-ray beam. In addition you can set whether you want to activate the crosshair together with the laser positioning device ( Ch. 18.1, p. 18-1) when pressing the Laser button. Fig Crosshair Crosshair activated: The crosshair is always displayed in the image on the live monitor. Crosshair deactivated: No crosshair is displayed on the live monitor. When you switch on the system, the crosshair is deactivated by default. If you display the crosshair during operation, this setting will be valid only for the current session. with Laser on activated: When you press the Laser button, the crosshair is activated together with the laser positioning device. with Laser on deactivated: When you press the Laser button, only the laser positioning device is activated. To display the crosshair, do the following: Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. 20-4

239 20 System Configuration Press the Crosshair option. The check box receives a check mark. Press the Apply button. The crosshair remains displayed until you switch off the system. To have the crosshair activated with the Laser button, do the following: Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. Press the Crosshair with Laser on option. The check box receives a check mark. Press the Apply button. When you press the Laser button, the crosshair is activated together with the laser positioning device Defining the start screen Under Start Screen you determine which operating mode is activated by default after power-up of the. Fig Start screen The following options are available: Fluoro: After power-up of the system, the Fluoroscopy operating mode is activated. Subtraction: After power-up of the system, the Subtraction operating mode is activated. Patient: After power-up of the system, the Patient operating mode is activated. The default start screen is configured according to the customer s wishes. To define the start screen, do the following: Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. Press the option for the desired operating mode. 20-5

240 20 System Configuration Press the Apply button. As from the next power-up of the system, the selected operating mode will be activated automatically Cine loop settings Under Cine you preset the recording speed (frame rate) and length for the acquisition of cine loops. You can change these preset values during operation for each cine loop you acquire. Fig Cine loop settings To preset the recording speed for cine loops, do the following: Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. Select the desired value for the recording speed (in frames per second) under Rate with the help of the arrow buttons. Press the Apply button. When you acquire a cine loop, the selected value is preset under Frames/s ( p. 12-3). To preset the length of cine loops, do the following: Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. Select the desired number of frames under Length with the help of the arrow buttons. Press the Apply button. When you acquire a cine loop, the selected value is preset under Length ( p. 12-3). 20-6

241 20 System Configuration Showing or hiding the native image Under DSA you determine whether the native image is displayed on the reference monitor during generation of a DSA/MSA/RSA ( Ch. 13.2, p. 13-2, Ch. 13.3, p. 13-4, Ch. 13.4, p. 13-5). Fig Showing or hiding the native image Native on activated: When you generate a DSA cine loop or MSA/RSA images, the native image is displayed on the reference monitor. Native on deactivated: When you generate a DSA cine loop or MSA/RSA images, the native image is not displayed. Before switching to the Subtraction operating mode, you may open a reference image on the reference monitor, which remains displayed there during the entire subtraction process. To display the native image in the Subtraction operating mode, do the following: Press the Config tab. The Configuration operating mode is activated. The Operation Settings controls appear. Press the option Native on under DSA. The check box receives a check mark. Press the Apply button. When you generate a DSA cine loop or MSA/RSA images, the native image is displayed on the reference monitor Discarding the operation settings After having defined or modified the operation settings, these settings must be applied first in order to become valid in the system. As long as the settings or changes have not been applied yet, you can discard them, so that the previous settings remain valid. To discard the operation settings which have not been applied yet, do the following: Press the Cancel button. or Quit the Configuration operating mode without applying the settings. 20-7

242 20 System Configuration 20.3 Basic settings Function Under Basic Settings you make different settings which directly affect the user interface, e.g. default data for the date or department. Usually, the basic settings are made by the service engineer when putting the system into service. However, you can modify the basic settings if you wish to. Press the Basic Settings button. The controls and input boxes for the basic settings are displayed in the dynamic control area. Fig Basic settings Setting the system date and the system time The system date and the system time must be entered once in order to enable the unit to store and display the date and time of saving together with the image data. Date format The displayed date format may vary depending on the customer-specific settings (order of day, month and year; dot or slash as date separator). The set date format is also used for displaying patient data in the Patient ( Ch. 10.2, p. 10-2) and Archive ( Ch. 10.3, p. 10-7) operating modes. Throughout this manual, the DD.MM.YYYY date format is used. If you want to change the date format, please contact your service engineer. 20-8

243 20 System Configuration To set the system date and system time, do the following: Press the Config tab. The Configuration operating mode is activated. Press the Basic Settings button. The controls and input boxes for the basic settings are displayed in the dynamic control area. Press the Time button. The button is highlighted in yellow, and the cursor jumps to the Time input box. Enter the system time in the Time input box using the format hh:mm:ss. Press the Date button. The button is highlighted in yellow, and the cursor jumps to the Date input box. Enter the system date in the Date input box. Press the Apply button Determining the live monitor Under Live Image you determine which monitor will serve as the live monitor. The live monitor is the monitor where the live fluoroscopic image is displayed. The remaining monitor serves as reference monitor, where the saved fluoroscopic images from the image memory are opened and displayed. Fig Determining the live monitor The following options are available: Live Image left: The left monitor is the live monitor and the right monitor is the reference monitor Live Image right: The right monitor is the live monitor and the left monitor is the reference monitor 20-9

244 20 System Configuration To determine the live monitor, do the following: Press the Config tab. The Configuration operating mode is activated. Press the Basic Settings button. The controls and input boxes for the basic settings are displayed in the dynamic control area. Press the option Live Image left or Live Image right. Press the Apply button Entering the hospital data In order to avoid having to type the same hospital data for each new patient folder you create, you can enter default data for the Hospital, Department and Doctor input boxes ( Ch , p. 10-3). This data appears automatically in the Patient operating mode. To define default data for the Hospital, Department and Doctor input boxes, do the following: Press the Config tab. The Configuration operating mode is activated. Press the Basic Settings button. The controls and input boxes for the basic settings are displayed in the dynamic control area. Press the Hospital button. The button is highlighted in yellow, and the cursor jumps to the Hospital input box. Enter the desired name in the Hospital input box. Press the Department button and enter the desired name in the Department input box. Press the Doctor button and enter the desired name in the Doctor input box. Press the Apply button

245 20 System Configuration Discarding the basic settings After having defined or modified the basic settings, these settings must be applied first in order to become valid in the system. As long as the settings or changes have not been applied yet, you can discard them, so that the previous settings remain valid. To discard the basic settings which have not been applied yet, do the following: Press the Cancel button. or Quit the Configuration operating mode without applying the settings Monitor / Dose Under Monitor / Dose, you can define the initial settings for the monitors, check proper functioning of the integrated ambient light sensor and perform a dose meter check ( Appendix A.1.4, p. A-2). Function Fig Monitor settings, ambient light sensor Under Brightness and Contrast you define the default settings for both monitors after power-up of the system. Initial settings for monitors 20-11

246 20 System Configuration To define the initial settings for the monitors, do the following: Press the Monitor / Dose button. The monitor setting controls appear. Fig Initial monitor settings Use the arrow buttons under Brightness and Contrast to set the desired brightness and contrast. Press the Apply button. The values for the initial monitor settings are saved now. When you switch on the system the next time, the chosen initial monitor settings are valid. Ambient light sensor The ambient light sensor is always active. It measures the ambient light level and continuously readjusts the screen brightness to match any change in the ambient light conditions. The readjustment procedure is quite slow (up to 1 minute in duration) in order to suppress monitor flickering. Fig Sensor indicator To check the correct functioning of the ambient light sensor, do the following: Press the Monitor / Dose button. Watch the Sensor indicator to see whether the ambient light sensor reacts to changes in the ambient light level

247 20 System Configuration 20.5 Storage media Under Storage Media you can define the graphics formats used for saving images to different storage media and delete data from different external storage media. Function Fig Storage media Images in the following graphics formats have a file size of approx. 2 MB: 8 bit BMP 16 bit TIF DICOM Multimedia Besides that, you may also save the images with reduced resolution and color depth in the following formats: DICOM Bit JPEG Images with reduced resolution and color depth have a file size of approx. 256 KB (1/4 MB). Image file sizes 20-13

248 20 System Configuration Floppy disk storage format Graphics formats When you save selected images to a floppy disk in the Archive operating mode ( p ), the images are saved automatically in 8 bit BMP format. Consequently, 8 Bit BMP is automatically set under Floppy Format. Fig Floppy disk format Defining the USB device storage format Graphics formats For saving selected images to a USB storage device in the Archive operating mode ( p ), the following graphics formats are available: TIF with a color depth of 16 bit (for further use on a PC) JPEG with a resolution of pixels and a color depth of 8 bit (for further use on a PC) DICOM (for further use on a DICOM network or viewing with a DICOM viewer) DICOM with a resolution of pixels and a color depth of 8 bit (for further use on a DICOM network or viewing with a DICOM viewer) Under USB Format you determine which of these graphics formats is used for saving images to a USB storage device. In the Archive operating mode, you have no possibility to set the desired graphics format when saving. Fig USB Format 20-14

249 20 System Configuration To define the USB device storage format, do the following: Press the Config tab. The Configuration operating mode is activated. Press the Storage Media button. Press the desired storage format option under USB Format. Press the Apply button Defining the CD / DVD storage format Depending on the chosen configuration, your may be equipped with a CD writer or alternatively with a DVD writer. With a CD writer, data can be written to or retrieved from CDs only. With a DVD writer, data can be written to or retrieved from both CDs and DVDs. CD writer or DVD writer For writing selected images to CD or DVD in the Archive operating mode ( p ), the following graphics formats are available: Graphics formats TIF with a color depth of 16 bit (for further use on a PC) JPEG with a resolution of pixels and a color depth of 8 bit (for further use on a PC) DICOM (for further use on a DICOM network or viewing with a DICOM viewer) DICOM with a resolution of pixels and a color depth of 8 bit (for further use on a DICOM network or viewing with a DICOM viewer) Multimedia (Video CD or MPEG2 format, for playback on a PC and DVD player) Under CD/DVD you determine which of these graphics formats is used for writing images to CD or DVD. In the Archive operating mode, you have no possibility to set the desired graphics format when saving. Fig CD/DVD format 20-15

250 20 System Configuration To define the CD/DVD storage format, do the following: Press the Config tab. The Configuration operating mode is activated. Press the Storage Media button. Press the desired storage format option under CD / DVD Format. Press the Apply button Deleting data from storage media To delete all images from a floppy disk, do the following: Press the Config tab. The Configuration operating mode is activated. Press the Storage Media button. Press the Erase Floppy Disk button. The following confirmation prompt is displayed: Do you really want to erase the floppy disk? Confirm by pressing the Yes button. All images are deleted from the floppy disk. To delete all images from a USB storage device, do the following: Press the Config tab. The Configuration operating mode is activated. Press the Storage Media button. Press the Erase USB button. The following confirmation prompt is displayed: Do you really want to erase the USB device? Confirm by pressing the Yes button. All images are deleted from the USB storage device

251 C-Arm Power Assist (U.S. Option) Function The C-arm Power Assist an optional accessory for peripheral vascular flow procedures is a joystick-controlled, motor-driven package for power-assisted positioning of the mobile imaging system. One set of motors drives the mobile imaging system left and right, parallel to the patient, while another motor extends and retracts the C-arm across the patient. Therefore, the C-arm can be driven, instead of pushed, along a desired path to visualize the vascular anatomy of a contrast media injection. Note The C-arm Power Assist does not contain any additional circuitry that emits electromagnetic interference, and is not affected by electromagnetic interference Operating instructions Each steering wheel has a cable guard to push cables on the floor out of the way. These guards interfere with the power-assisted drive engagement when they are in the upward position. Therefore, make sure that all guards are pushed down before engaging the Power Assist. Fig Push cable guards down EN

252 21 C-Arm Power Assist (U.S. Option) 21.3 Using the C-arm Power Assist Pull the steering & braking lever upward to release the wheel brake ( Fig. 21-2, p. 21-2). Stand at the rear of the C-arm and turn the steering & braking lever clockwise until you see the green engagement indicator light illuminate. This will occur when the handle points directly to the left. Note Notice that in power-assist mode the direction of the lower wheels is fixed parallel to the patient. Release the extend/retract brake on the C-Arm. Drive system status light (green when lit) Steering & braking lever. Pull up to release brake. Fig Steering & braking lever and indicator light Hold the joystick (in either hand) with the flat portion of the joystick body towards you. Rest your thumb on the flat area of the joystick body, as shown in Fig. 21-3, p EN.00

253 21 C-Arm Power Assist (U.S. Option) Image grab button Rest thumb across flat portion of joystick body Use index finger to activate fluoro button Fig Joystick Note You should be facing the C-arm control panel when using the joystick. To drive the C-arm base left, push the joystick to the left and vice versa. Push the joystick back or forward to retract or extend the C- arm. There are two fluoro activation buttons. Press either to activate fluoroscopy. WARNING Use care when handling the joystick. The buttons on the side of the joystick deliver an X-ray dose when pressed EN

254 21 C-Arm Power Assist (U.S. Option) EN.00

255 Appendix A.1 Regular checks A.1.1 Routine checks to be performed by the user The following safety checks must be performed at regular intervals: Check Interval Remarks X-ray generator Monthly Check for physical damage. Radiation switches Monthly Must initiate radiation only if pressed permanently. Releasing them must terminate radiation after 1 sec max. (depending on the stack filter settings). Radiation signals Monthly During the exposure, the yellow radiation warning lamp on top of the monitor housing and the X-ray symbol on the control panel must be illuminated. Audible alarm Monthly Must sound in direct radiography mode during the whole exposure time, and in fluoroscopy mode after 5 min. Information labels Monthly All warning and information labels must be properly attached and easily legible. Power cable Monthly Must not show any signs of physical damage. C-arm stand wheels Whenever necessary Clean when dirty. Table A-1 Regular checks Note A detailed maintenance schedule can be found in the Technical Manual. Technical information necessary to repair or upgrade the system will be made available by Ziehm Imaging to authorized and qualified personnel upon request. A-1

256 Appendix A.1.2 Consistency test according to national regulations At regular intervals, at least once a month, you must check whether the system shows any deviations from the reference values by performing a consistency test. Note The relevant radiation protection regulations of the country of installation must be observed. A.1.3 Checking the exposure rate control Quantitative method: The system is in its initial state after switching it on. The following value must be achieved: 70+3kV Measured with a patient equivalent filter 25 mm Al mm Cu inserted in the X-ray beam. A.1.4 Dose meter check (optional feature) Test interval You should check the dose meter each time you switch on the system. You must perform and document a dose meter check once a month when you perform the consistency test. To test the dose meter, do the following: Press the Config tab. The Configuration operating mode is activated. Press the Monitor / Dose button. The ambient light sensor indicator and the Dose Meter Check button appear in the dynamic control area. A-2

257 Appendix Fig. A-1 Sensor / dose meter check functions Press the Dose Meter Check button. The test is started. It takes 30 seconds. A message window with a progress indicator and the message DAP test running is displayed. A Cancel button appears in addition, enabling you to interrupt the check. Once the test is complete, and if the measured values are within the tolerance limits, the message DAP ok; actual value: xyz is displayed. If the measured values are beyond the tolerance limits, the following message appears: DAP fault; nominal value: x, actual value: y Confirm by pressing the Yes button. If the values are beyond the tolerance limits, repeat the dose meter check. If the values measured are still beyond the tolerance limits, contact your service engineer. A-3

258 Appendix A.1.5 Checking the useful beam Inspection interval Together with the consistency test, it is necessary to check the size and centering of the useful X-ray beam. Centering To determine the correct alignment of the ray beam to the center of the image intensifier and any possible deviation, do the following: Angulate the C-arm by 180, so that the X-ray generator is above and the image intensifier is below. Place a reference or test object (e.g. measuring board, graduated collimator test tool) exactly in the center of the image intensifier. Close the iris collimator as far as possible and initiate radiation by pressing the hand or foot switch. The object should appear exactly in the center of the fluoroscopic image. Collimator diameter accuracy The size of the collimator diameter in the image plane must not differ from the nominal image diameter by more than 2% of the source image receptor distance (SID). The SID and the nominal image diameter depend on the image intensifier size. Size SID Nominal image size 31 cm 97 cm Dia cm 23 cm 97 cm Dia cm Digital flat-panel detector 111 cm 19.8 cm 19.8 cm Table A-2 Nominal image diameter Maximum radiation field size When the iris collimator is completely open, the edges of the collimator must be just visible on the monitor. WARNING Contact your after-sales service center in case of any non-conformities! A-4

259 Appendix A.1.6 Leakage in the cooling system If you observe any moisture on the outside of the C-arm stand during operation, leakage of the cooling system might be the reason. Cooling may be diminished or fail completely in such cases. Moisture penetration If there is leakage in the generator area, the cooling pump switches off, and a message window with an alert appears on the control panel. Leakage in the generator WARNING Contact your after-sales service center in case of any moisture penetration or leakage of the generator! A.1.7 Gettering the image intensifier tube (n/a for FD) To increase the useful life of the image intensifier, we recommend gettering the image intensifier tube after a period of 6 months of continuous non-use or storage. Increasing the useful life To getter the image intensifier tube, do the following: Switch on the system. Leave it switched on for at least 1 hour. Do not initiate radiation during this time! We recommend keeping an operator s log, where all operating times, gettering times and maintenance events are recorded. Operator s log A.1.8 Gain adjustment and pixel correction ( FD) Every 6 months, gain adjustment and pixel correction must be carried out on a FD. Please contact your after-sales service center for that purpose. WARNING If the live image shows streaks although the gain adjustment and pixel correction procedures have been performed at regular intervals, please contact your after-sales service center! A-5

260 Appendix A.2 Cleaning, disinfection, sterilization Preparation Always switch off the system and disconnect it from the power supply before cleaning or disinfecting it. A.2.1 Cleaning Recommended detergents For cleaning the system, use only water with mild detergents applied with a damp cloth. Never use abrasive cleansing agents, organic solvents or detergents which contain solvents (e.g. alcohol, petroleum ether, liquid stain remover). WARNING Take care that no liquids penetrate into the unit through sockets, plugs, ventilation holes or gaps (at integrated external devices such as video printers or video cassette recorders). Never apply spray cleaners directly onto the unit! Cleaning the monitor screens For cleaning the monitor screens, use only pure alcohol or a mixture consisting of 1/3 alcohol and 2/3 distilled water. Wipe the screen and surrounding painted surfaces dry with a soft cotton cloth immediately after cleaning. A.2.2 Disinfection Please use one of the following tested and approved disinfectants: Terralin Dax YT Antifect AF Dilute the disinfectant according to the manufacturer s instructions. Dampen a cloth with the solution. Thoroughly wipe the outside of the unit with this cloth. No alcohol or Sagrotan Never use pure alcohol or Sagrotan, since these substances may corrode the surfaces. No disinfecting sprays Never use disinfecting sprays, since the liquid droplets may penetrate inside the unit, endangering safe system operation. Electronic modules may be damaged, and explosive air/solvent vapor mixtures may develop. A-6

261 Appendix A.2.3 Sterilization The disposable covers (optional accessories) are sterile upon delivery. CAUTION The disposable covers are not re-sterilizable. Be sure to discard the disposable covers properly after use! A.3 Faults A.3.1 Types of faults The following fault types are detected and indicated: A Alerts during power-up Alert messages are displayed in a message window on the control panel. An audible alarm sounds. If you get an alert message during system power-up, you can close the message window and continue to work with the system. However, the system will not be fully operational. Press the Yes button in the message window. The message window is closed. A Errors during power-up Error messages are displayed in a message window on the control panel. An audible alarm sounds. Although you can close the message window, you cannot continue to work with the system. Press the Yes button in the message window. The message window is closed. In some cases, a new message window with another error message is displayed. WARNING If an error message is displayed, the system is not ready for operation! The error must be corrected by your after-sales service center! Please communicate the error code number (E...) and the serial number of the system to your after-sales service center. A-7

262 Appendix A Alerts during operation Alert messages are displayed in a message window on the control panel. An audible alarm sounds. If you get an alert message during system operation, radiation is not interrupted, and you can continue to initiate radiation. However, the system will not be fully operational. Press the Yes button in the message window. The message window is closed. A Errors during operation Error messages are displayed in a message window on the control panel. An audible alarm sounds. Radiation is interrupted and you can no longer initiate any radiation. Press the Yes button in the message window. The message window is closed. In some cases, a new message window with another error message is displayed. WARNING If an error message is displayed, the system is not ready for operation! The error must be corrected by your after-sales service center! Please communicate the error code number (E...) and the serial number of the system to your after-sales service center. WARNING Please contact your after-sales service center also if a certain error occurs frequently! A.3.2 List of errors and alerts If an alert appears, do the following: Press the Yes button in the message window. The message window is closed. You may continue to work. The system is not fully operational. If an error occurs, do the following: Contact your after-sales service center. A-8

263 Appendix Code Type Description E1000 Error Thin filament defective E1001 Error Thick filament defective E1002 Error No V-Sync E1003 Error Operating temperature not yet reached, please wait E1004 Alert Cooling phase in process, please wait E1005 Error Temperature 2 too low E1006 Alert Temperature 2 too high E1007 Error Machine data corrupt E1008 Error Interrupt 1 flipflop defective E1009 Error Interrupt 2 flipflop defective E1010 Error HW signal XRay active during power-up E1011 Error CAN XRay Enable active during power-up E1012 Error D/A converter reference voltage defective E1013 Error D/A converter kv defective E1014 Error Oil overtemperature switch active E1015 Error Wrong machine data version E1016 Error Moisture sensor alarm E1050 Alert High-voltage fault E1051 Alert High-voltage fault (anode) E1052 Alert High-voltage fault (cathode) E1053 Alert ma peak value fault E1054 Alert kv nominal/actual value fault E1055 Alert ma nominal/actual value fault E1056 Alert XRay Enable fault E1057 Alert Life monitoring missing E1058 Alert Hardware monitoring missing E1059 Alert External radiation interrupt (XRayBreak) E1060 Alert Signal / XRay missing E1061 Alert High-voltage arc E1062 Alert Nominal kv value greater max. kv value E1063 Alert Nominal ma value greater max. ma value E1066 Alert CAN fault line active E1067 Error Basic heating faults Table A-3 List of error and alert messages A-9

264 Appendix Code Type Description E1068 Error V-Sync faults E1069 Alert Temperature sensor 1 E1070 Alert Temperature sensor 2 E1071 Error Signal / XRay without radiation E1072 Error Oil overtemperature switch active E1073 Error Moisture sensor alarm E1074 Error kv value too high (no radiation) E1095 Alert Generator overheated, recovery time %d seconds E1098 Error Generator power-up fault E1099 Error Generator fault E1100 Alert Hand switch 1 pressed during power-up E1101 Alert Hand switch 2 pressed during power-up E1102 Alert Foot switch 1 pressed during power-up E1103 Alert Foot switch 2 pressed during power-up E1104 Alert Foot switch 3 pressed during power-up E1105 Alert Foot switch 4 pressed during power-up E1106 Alert Foot switch 5 pressed during power-up E1107 Alert Foot switch 6 pressed during power-up E1108 Error Short circuit in hand switch 1 E1109 Error Short circuit in hand switch 2 E1110 Error Short circuit in foot switch 1 E1111 Error Short circuit in foot switch 2 E1112 Error Short circuit in foot switch 3 E1113 Error Short circuit in foot switch 4 E1114 Error Short circuit in foot switch 5 E1115 Error Short circuit in foot switch 6 E1116 Error XRay Enable present during power-up E1117 Error External I/O fault E1118 Error Wrong EEPROM checksum E1132 Alert Short circuit in hand switch 1 E1133 Alert Short circuit in hand switch 2 E1134 Alert Short circuit in foot switch 1 E1135 Alert Short circuit in foot switch 2 Table A-3 List of error and alert messages (cont.) A-10

265 Appendix Code Type Description E1136 Alert Short circuit in foot switch 3 E1137 Alert Short circuit in foot switch 4 E1138 Alert Short circuit in foot switch 5 E1139 Alert Short circuit in foot switch 6 E1140 Alert XRay Enable not active E1141 Alert CAN fault line active E1142 Alert External I/O fault E1143 Error Error Lifemonitoring Imaging System E1148 Alert Timeout post-fluoro time (LIH) E1164 Error Short circuit in hand switch 1 E1165 Error Short circuit in hand switch 2 E1166 Error Short circuit in foot switch 1 E1167 Error Short circuit in foot switch 2 E1168 Error Short circuit in foot switch 3 E1169 Error Short circuit in foot switch 4 E1170 Error Short circuit in foot switch 5 E1171 Error Short circuit in foot switch 6 E1172 Error XRay Enable without switch E1173 Error CAN fault line active E1174 Error External I/O fault E1175 Error Error Lifemonitoring Imaging System E1197 Error Main interface XRay break fault E1198 Error Main interface power-up fault E1199 Error Main interface fault E1200 Error Timeout main interface (1) E1201 Error Timeout main interface (2) E1202 Error Timeout while reading power-up errors E1203 Error Timeout generator machine data (1) E1204 Error Timeout generator machine data (2) E1205 Error Timeout generator machine data (3) E1206 Error Timeout generator pulse width E1207 Error Timeout filament selection E1208 Error Timeout measuring range selection Table A-3 List of error and alert messages (cont.) A-11

266 Appendix Code Type Description E1209 Error Timeout kvma setpoint value E1210 Error Timeout while reading collimator limit value (1) E1211 Error Timeout while reading collimator limit value (2) E1212 Error Timeout ack system running E1213 Alert Timeout while reading XRay break errors E1214 Alert Timeout XRay break: interface busy E1215 Error Internal error %d E1216 Alert Internal alert %d E1217 Error Error while clearing hard disk %d E1218 Error Timeout CAN module %d E1219 Error Unexpected ACK from CAN module %d E1220 Alert XRay assigned to function switch (%d), ignored! E1221 Alert XRAY command assigned to function switch (%d), ignored! E1222 Alert Temperature limit alert: Reduce radiation power! E1223 Error CAN bus cannot be addressed during power-up! E1224 Error CAN module missing: E1225 Alert Radiation allowed after technique values are displayed! E1226 Error CAN modules missing: E1227 Error CAN module faulty: %d E1228 Error CAN module 6 U544 faulty E1229 Error CAN bus faulty BUS OFF E1230 Error Only CAN module 6 U544 present E1231 Error CAN module(s) not connected correct ( stand alone? ) E1232 Error Timeout: no answer from a CAN module E1233 Error Memory full. Image can not be stored! E1234 Error dis8000.ini missing! E1235 Error No acknowledge to %d from %d E1299 Error Image system fault E1300 Error SPI interface MAX 504 E1301 Alert Overtemperature E1302 Error Reference voltage MAX 504 E1303 Error Output voltage MAX 504 E1304 Error Wrong EEPROM checksum Table A-3 List of error and alert messages (cont.) A-12

267 Appendix Code Type Description E1350 Error SPI interface MAX 504 E1351 Alert Overtemperature E1352 Alert Actual value too high E1353 Alert Actual value too low E1354 Error Output voltage MAX 504 E1355 Error CAN fault line active E1358 Alert Output voltage beyond tolerance E1398 Error PPS power-up fault E1399 Error PPS fault E1400 Error Servo %d position fault E1401 Error Servo %d not connected E1402 Error Servo %d not ready E1449 Error Vision Track fault E1450 Error Servo position fault E1451 Error Servo not connected E1452 Error Servo not ready E1499 Error II power supply fault E1500 Alert Radiation alert lamp defective E1501 Alert CRT high voltage E1502 Alert Video voltage E1503 Alert Video signal E1504 Alert CRT filament E1505 Alert Horizontal deflection E1506 Alert 150V supply E1507 Alert Vertical deflection E1508 Error Wrong EEPROM checksum E1509 Alert V-Blank signal missing E1516 Alert Radiation alert lamp defective E1517 Alert CRT high voltage E1518 Alert Video voltage E1519 Alert Video signal E1520 Alert CRT filament E1521 Alert Horizontal deflection Table A-3 List of error and alert messages (cont.) A-13

268 Appendix Code Type Description E1522 Alert 150V supply E1523 Alert Vertical deflection E1599 Error Monitor fault E1600 Alert Busy printer 1 active E1601 Alert Busy printer 2 active E1602 Error Wrong EEPROM checksum E1620 Alert Printer 1 busy error E1621 Alert Printer 1 busy error E1622 Alert Printer 1 busy error E1628 Alert Printer 2 busy error E1629 Alert Printer 2 busy error E1630 Alert Printer 2 busy error E1649 Error U525 fault E1700 Alert kvma table: kv not ascending E1701 Alert kvma table: Power not ascending E1702 Alert kvma table not finished E1703 Alert kv maximal value too high E1704 Alert ma maximal value too high E1705 Error No extern video signal E1708 Error Generator pulse error E1709 Error No VSync E1710 Error No interrupt E1711 Error No communication PPC-generator E1712 Error ma from generator invalid E1713 Error XRAY not allowed E1714 Error Max ma value cannot be read E1716 Error SDRAM PPC defective E1717 Error GammaLUT PPC defective E1718 Error Offset adjustment not possible E1719 Error Gain adjustment not possible E1720 Error Hardware Version, Release E1721 Error IRQ3 error E1722 Error VSync corrupt 30/25 Hz Table A-3 List of error and alert messages (cont.) A-14

269 Appendix Code Type Description E1723 Error Video standard unknown E1724 Error Boot program unknown E1725 Error M-Data unknown E1726 Alert Collimator does not support DAP values E1727 Error Flatpanel not supported in this version E1732 Error Reference voltage defektive E1733 Error AD14 offset adjustment defektive E1734 Error AD14 gain adjustment defektive E1735 Error AD14 gain*4 adjustment defektive E1736 Error AD8 offset adjustment defektive E1737 Error AD8 gain adjustment defektive E1738 Error No extern video signal E1740 Error Hardware doesn t support grid regulation E1741 Error Hardware doesn t support motion detection E1742 Error Hardware doesn t support DAP calculation E1743 Error Hardware doesn t support automatic dose reduction E1799 Error Error PPC Table A-3 List of error and alert messages (cont.) A-15

270 Appendix A.4 Labels on the For U.S.A., see p. A-40 1* I D H B G F 2) E C I Fig. A-2 Labels on the C-arm stand () 1* H I D B G F 2) C I E Fig. A-3 Labels on the C-arm stand ( FD) A-16

271 Appendix E J 1) J 1) Fig. A-4 Labels on systems with laser positioning device on the image intensifier (left) and on the generator (right) E J 1) 1) J Fig. A-5 Labels on systems with laser positioning device on the digital flat-panel detector (left) and on the generator (right) ( FD) A-17

272 Appendix 1( 1^ (optional) 1& 1! G 1# Fig. A-6 1$ 1@ Labels on a monitor cart with flat-screen monitors 1% 1^ (optional) 1( 1^ (optional) 1& 1! G 1# Fig. A-7 1$ 1@ Labels on a monitor cart with CRT monitors 1% 1^ (optional) A-18

273 Appendix No. Label Comments B FD Table A-4 Labels on the (outside the U.S.A.) A-19

274 Appendix No. Label Comments C FD Table A-4 Labels on the (outside the U.S.A.) (cont.) A-20

275 Appendix No. Label Comments D FD E F G Please observe accompanying documents! H I J Only on systems with laser positioning device 1) Only on systems with laser positioning device Table A-4 Labels on the (outside the U.S.A.) (cont.) A-21

276 Appendix No. Label Comments 1!, only on 200V systems sold in Japan, only on 100V systems sold in Japan Table A-4 Labels on the (outside the U.S.A.) (cont.) A-22

277 Appendix No. Label Comments 1! FD Equipotential grounding 1# Spare earth ground connection 1$ Protection Class I, Type B 1% Only on systems sold in Japan 1^ DICOM Only on systems with DICOM option and RJ45 connection, connection optionally either in the upper or lower half of the monitor cart 1& TX RX Only on systems with DICOM option and fiberoptic connection Table A-4 Labels on the (outside the U.S.A.) (cont.) A-23

278 Appendix No. Label Comments 1* FD Table A-4 Labels on the (outside the U.S.A.) (cont.) A-24

279 Appendix No. Label Comments 1( FD 2) Only on systems sold in China Table A-4 Labels on the (outside the U.S.A.) (cont.) A-25

280 Appendix A.5 Focal spot position A.5.1 Reference axis Horizontal deviation of X-ray tube Focal spot (red dot) Anode angle Fig. A-8 Focal spot position on systems with 23 cm i.i. (Ziehm Vision) A-26

281 Appendix A.5.2 FD Reference axis 1110 Focal spot (red dot) Fig. A-9 Focal spot position on systems with digital flat-panel detector ( FD) A-27

282 Appendix A.6 Heat capacity Heating curve Temp. ( C) 80 Heating curve at 110 kv / 3.2 ma (Heat capacity 800,000 J, continuous heat dissipation 50 W) Time (min.) Fig. A-10 Heating curve (Model D-064R) Cooling curve Temp. ( C) 90 Cooling curve Time (min.) Fig. A-11 Cooling curve (Model D-064R) A-28

283 Appendix A.7 Scattered radiation in the significant zone of occupancy A.7.1 Distribution of scattered radiation in the significant zone of occupancy of the C- arm stand Measurement conditions in accordance with EN :1994 Exposure conditions: Automatic control, 76 kv / 5.9 ma / 448 W Rectangular water phantom 25 cm 25 cm 15 cm mm Cu Measuring instrument: Radcal 9015 Copper Water phantom Height above floor in cm 45 cm X-ray focus floor : 25 cm phantom image intensifier anti-scatter grid distance Distance to central ray beam in cm Patient positioning Significant zone of occupancy cm Fig. A-12 Scattered radiation A-29

284 Appendix A.7.2 FD Distribution of scattered radiation in the significant zone of occupancy of the C- arm stand Measurement conditions in accordance with EN :1994 Exposure conditions: Automatic control, 89 kv / 15.8 ma / pulse duration 16 ms / 30 pulses/s / 700 W Rectangular water phantom 25 cm 25 cm 15 cm mm Cu Measuring instrument: Radcal 1515 Copper Water phantom Significant zone of occupancy cm Fig. A-13 Scattered radiation FD A-30

285 Appendix A.8 Dimensions C-arm stand with 31 cm i.i Fig. A-14 Dimensions of a C-arm stand with 31 cm i.i. A-31

286 Appendix C-arm stand with 23 cm i.i Fig. A-15 Dimensions of a C-arm stand with 23 cm i.i. A-32

287 Appendix FD C-arm stand Fig. A-16 Dimensions of a FD C-arm stand A-33

288 Appendix Monitor cart with 18.1" flat-screen monitors Fig. A-17 Dimensions of a monitor cart with 18.1" flatscreen monitors Monitor cart with CRT monitors Fig. A-18 Dimensions of a monitor cart with CRT monitors A-34

289 Appendix A.9 Technical data For U.S.A., see p. A-48 A.9.1 System Nominal supply voltage / frequency Power supply fuse rating Required residual current circuit breaker (RCD) Nominal supply current Power supply in standby mode Internal fusing Maximum line impedance Equipment protection classification Radiation controlled area (with generator in lowermost position and C- arm vertical) 230 V AC, 50/60 Hz L 16 A I N 16 A, I AN = 30 ma 8 A continuous, 16 A short-time 1.95 A / 450 W (applies to the following configuration: CRT monitors, printer UP-980, CD writer, floppy disk drive) The values depend on the integrated documentation systems. 15 A quick-blow (2 pcs.) 0.6 Ω Protection Class I, Type B ( continuous operation 23/31 cm i.i. and digital flatpanel detector: ), ordinary equipment, 4 m Table A-5 Technical data of the A-35

290 Appendix Power Direct radiography: (n/a for FD) Fluoroscopy: kv 15 ma min./20 ma max., 1.5 mas min./100 mas max kv ma Pulsed mode: Pulse width ms; FD: Pulse width 16 ms (invariable); Digital radiography (snapshot): 1, 2, 4, 8, 12.5, 25 pulses/s (systems with 25 pulses/s) 1, 5, 10, 15, 30 pulses/s (systems with 30 pulses/s, also FD) kv 0.1 ma min./20 ma max. Generator Max. operating data Max. power output Nominal electric power X-ray tube Focal spot nominal size, with respect to reference axis ( Fig. A-8, p. A-26) Focal spot horizontal tolerance, with respect to reference axis ( Fig. A-8, p. A-26) Operating frequency: Fluoroscopy: Direct radiography: (n/a for FD) Digital radiography: 40 khz 110 kv / 18 ma 80 kv / 20 ma 110 kv / 15 ma 80 kv / 20 ma 110 kv / 18 ma 80 kv / 20 ma Fluoroscopy: 1980 W (110 kv / 18 ma) Direct radiography: 1650 W (110 kv / 15 ma) Digital radiography: 1980 W (110 kv / 18 ma) 2000 W at 100 kv / 20 ma / 0.1 s Single-focus stationary-anode tube 0.6 acc. to IEC +/- 0.5 mm (controlled) Table A-5 Technical data of the (cont.) A-36

291 Appendix Generator Image intensifier Anode angle, with respect to reference axis ( Fig. A-8, p. A-26) Anode material Total filtration Maximum X-ray tube loading factors for 1h;3mA (at 110 kv) Tube 9 Tungsten : 3 mm Al, including 0.05 mm Cu FD: 3 mm Al mas/h Scintillator: Nominal sizes: Anti-scatter grid Pb 8/40 Cesium iodide 31 / 23 / (17) cm or 23 / 17 / (10) cm Digital flat-panel detector Monitors Environmental conditions Detector Scintillator: Size: Resolution: Anti-scatter grid Pb 8/ " flat-screen monitors Screen size: Resolution: CRT monitors Screen size: Bandwidth: Resolution: During storage Temperature: Relative air humidity: During operation Temperature: Relative air humidity: Cesium iodide 19.8 cm 19.8 cm mm (18.1") / 50 Hz 440 mm (17") 100 MHz 1125 lines / 75 Hz 10 C to +60 C 95% max. +15 C to +35 C 75% max. Table A-5 Technical data of the (cont.) A-37

292 Appendix Dimensions Weight C-arm Source/image receptor distance: Vertical free space (generator/i.i.): Vertical free space (generator/digital flat-panel detector): Immersion depth: Orbital rotation: Angulation: Swiveling (panning): Horizontal movement: Vertical movement: 970 mm 750 mm 895 mm 680 mm 115 / 135 a ± 225 ± mm 430 mm C-arm stand With 23 cm i.i. approx. 280 kg (also applies to FD) Monitor cart With flat-screen monitors: approx. 183 kg With CRT monitors: approx. 203 kg Table A-5 Technical data of the (cont.) a. Option, not available with 31 cm i.i. CAUTION Temperatures above 40 C and relative air humidity above 60% may cause stains on the printer s heat-sensitive paper. WARNING If you expect ambient air temperatures below 0 C, empty the cooling tank in the C-arm stand foot with the help of the two filler and vent hoses supplied with the system. Re-fill the cooling tank with water before putting the system into service. A-38

293 Appendix A.9.2 Laser positioning device Laser Class Class 2M acc. to IEC : Max. power output < 1 mw of continuous laser radiation, measured at the laser beam apertures Wavelength of the radiation 635 nm Table A-6 Technical data of laser positioning device A.9.3 Dose measurement chamber Absorber Sensitivity (75 kv; 2.7 mm Al HVL) Measuring range of DAP power Voltage range 2.8 mm Al pc mgy cm 2 ( ) mgy cm 2 /s (35 150) kv Voltage correction Fig. A-19, p. A-40 Aluminum equivalent < 0.4 mm Table A-7 Technical data of dose measurement chamber A-39

294 Appendix Voltage correction (Absorber: 2.8 mm Al filtration taken into consideration) Correction factor Fig. A-19 Voltage correction of dose measurement chamber A.10 Labels on the (U.S.A.) 1# 3$ 1$ 1* 1^ 1& 1% 1$ H 1$1%1^ 1& 3% +3& 3# +3* i 3@ +3^ 3! G 3) 1# 2( 1!+1@ C+E B J Fig. A-20 Labels on the C-arm stand (U.S.A.) A-40

295 Appendix I 1& 1% 1$ 1$ 1% 1* 1* 1^ 1& Fig. A-21 Labels on systems with laser positioning device on the image intensifier (left) and on the generator (right) (U.S.A.) 2* 2* 2% 2& 1( 2) 2^ 2$ 1) 2@ Fig. A-22 2# Labels on a monitor cart with flat-screen monitors (U.S.A.) A-41

296 Appendix 2* 2* 2% 2& 1( 2) 2^ 2$ 1) 2# Fig. A-23 Labels on a monitor cart with CRT monitors (U.S.A.) No. Label Comments B C D Only on systems sold in Canada Table A-8 Labels on the (U.S.A.) A-42

297 Appendix No. Label Comments E F Only on systems sold in Canada G H I J Table A-8 Labels on the (U.S.A.) (cont.) A-43

298 Appendix No. Label Comments 1) Please observe accompanying documents! 1! Only on systems sold in Canada 1# 1$ Only on systems with laser positioning device 1% Only on systems with laser positioning device 1^ Only on systems with laser positioning device 1& Only on systems with laser positioning device 1* Only on systems with laser positioning device Table A-8 Labels on the (U.S.A.) (cont.) A-44

299 Appendix No. Label Comments 1( a 1( b Only on 220 V AC systems sold in the U.S.A. 2) 2! Only on systems sold in Canada 2@ Equipotential grounding 2# Spare earth ground connection 2$ Protection Class I, Type B 2% Table A-8 Labels on the (U.S.A.) (cont.) A-45

300 Appendix 2^ No. Label Comments Only on systems with DICOM option and RJ45 connection, connection optionally either in the upper or lower half of the monitor cart 2& Only on systems with DICOM option and fiber-optic connection 2* 2( 3) 3! Table A-8 Labels on the (U.S.A.) (cont.) A-46

301 Appendix No. Label Comments 3^ Only on systems sold in Canada 3# 3* Only on systems sold in Canada 3$ 3% 3& Only on systems sold in Canada Table A-8 Labels on the (U.S.A.) (cont.) A-47

302 Appendix A.11 Technical data (U.S.A.) System Nominal supply voltage / frequency 120 V AC, 60 Hz 230 V AC, 60 Hz Power supply fuse rating L 20 A L16 A Required residual current circuit breaker (RCD) Nominal supply current Power supply in standby mode I N 20 A, I AN = 30 ma 10 A continuous, 22 A short-time I N 16 A, I AN = 30 ma 8 A continuous, 16 A short-time 3.75 A / 450 W 1.95 A / 450 W (applies to the following configuration: CRT monitors, printer UP-980, CD writer, floppy disk drive) The values depend on the integrated documentation systems. Internal fusing 20 A quick-blow (2 pcs.) 15 A quick-blow (2 pcs.) Maximum line impedance 0.6 Ω 0.6 Ω Equipment protection classification Radiation controlled area (with generator in lowermost position and C- arm vertical) Protection Class I, Type B ( continuous operation ), ordinary equipment, 23/31 cm i.i.: 4 m 23/31 cm i.i.: 4 m Table A-9 Technical data of the (U.S.A.) A-48

303 Appendix Generator Image intensifier Power Direct radiography: Fluoroscopy: kv 15 ma min./20 ma max., 1.5 mas min./100 mas max kv ma Pulsed mode: Pulse width ms 1,2,5,10,15,30 pulses/s Digital radiography (snapshot): kv 0.1 ma min./20 ma max kv 15 ma min./20 ma max., 1.5 mas min./100 mas max kv ma Operating frequency: 40 khz 40 khz Max. operating data Fluoroscopy Direct radiography: Digital radiography: Max. power output 110 kv / 15 ma 80 kv / 20 ma 110 kv / 15 ma 80 kv / 20 ma 110 kv / 15 ma 80 kv / 20 ma Pulse width ms 1,2,5,10,15,30 pulses/s kv 0.1 ma min./20 ma max. 110 kv / 18 ma 80 kv / 20 ma 110 kv / 15 ma 80 kv / 20 ma 110 kv / 18 ma 80 kv / 20 ma Fluoroscopy: 1650 W (110 kv / 15 ma) 1980 W (110 kv / 18 ma) Direct radiography: 1650 W (110 kv / 15 ma) 1650 W (110 kv / 15 ma) Digital radiography: 1650 W (110 kv / 15 ma) 1980 W (110 kv / 18 ma) Nominal electric power X-ray tube 2000 W at 100 kv / 20 ma / 0.1 s Single-focus stationary-anode tube Focal spot nominal size 0.6 acc. to IEC 0.6 acc. to IEC Total filtration 3 mm Al, including 0.05 mm Cu Tube Scintillator: Cesium iodide Nominal sizes: 31 / 23 / (17) cm or 23 / 17 / (10) cm Anti-scatter grid Pb 8/40 Pb 8/40 Table A-9 Technical data of the (U.S.A.) (cont.) A-49

304 Appendix Monitors Environmental conditions Dimensions Weight 18.1" flat-screen monitors Screen size: Resolution: CRT monitors Screen size: Bandwidth: Resolution: During storage During operation C-arm C-arm stand Monitor cart 460 mm (18.1") 460 mm (18.1") / 60 Hz / 50 Hz 440 mm (17") 440 mm (17") 100 MHz 100 MHz 1068 lines / 90 Hz 1125 lines / 75 Hz Temperature: 10 C to +60 C Relative air humidity: 95% max. Temperature: +15 C to +35 C Relative air humidity: 75% max. Source/image receptor distance: 970 mm Vertical free space (generator/i.i.): 750 mm Immersion depth: 680 mm Orbital rotation: 115 / 135 a Angulation: ± 225 Swiveling (panning): ±10 Horizontal movement: 220 mm Vertical movement: 430 mm With 23 cm i.i.: approx. 280 kg With flat-screen monitors: approx. 183 kg With CRT monitors: approx. 203 kg Table A-9 Technical data of the (U.S.A.) (cont.) a. Option, not available with 31 cm i.i. A-50

305 Appendix A.12 Technical data (Japan) System Generator Nominal supply voltage / frequency 100 V AC, 50/60 Hz 230 V AC, 50/60 Hz Power supply fuse rating 20 or 30 A 20 or 30 A Required residual current circuit breaker (RCD) Nominal supply current Power supply in standby mode I N 20 A, I AN = 30 ma 10 A continuous, 22 A short-time I N 16 A, I AN = 30 ma 8 A continuous, 16 A short-time 450 VA (4.5 A) 450 VA (2.25 A) (applies to the following configuration: CRT monitors, printer UP-980, CD writer, floppy disk drive) The values depend on the integrated documentation systems. Internal fusing 20 A quick-blow (2 pcs.) 15 A quick-blow (2 pcs.) Maximum line impedance 0.6 Ω 0.6 Ω Equipment protection classification Radiation controlled area (with generator in lowermost position and C- arm vertical) Power Direct radiography: Fluoroscopy: Protection Class I, Type B ( continuous operation ), ordinary equipment, 23/31 cm i.i.: 4 m 23/31 cm i.i.: 4 m kv 12 ma min./20 ma max., 1.5 mas min./100 mas max kv ma Pulsed mode: Pulse width ms 1,2,5,10,15,30 pulses/s Digital radiography (snapshot): kv 0.1 ma min./20 ma max kv 15 ma min./20 ma max., 1.5 mas min./100 mas max kv ma Operating frequency: 40 khz 40 khz Pulse width ms 1,2,5,10,15,30 pulses/s kv 0.1 ma min./20 ma max. Table A-10 Technical data of the (Japan) A-51

306 Appendix Generator Video standard of output Image intensifier Max. operating data Fluoroscopy Direct radiography: Digital radiography: Max. power output 110 kv / 12 ma 65 kv / 20 ma 110 kv / 12 ma 65 kv / 20 ma 110 kv / 12 ma 65 kv / 20 ma 110 kv / 18 ma 80 kv / 20 ma 110 kv / 15 ma 80 kv / 20 ma 110 kv / 18 ma 80 kv / 20 ma Fluoroscopy: 1320 W (110 kv / 12 ma) 1980 W (110 kv / 18 ma) Direct radiography: 1320 W (110 kv / 12 ma) 1650 W (110 kv / 15 ma) Digital radiography: 1320 W (110 kv / 12 ma) 1980 W (110 kv / 18 ma) Nominal electric power (IEC , 6.8.2) X-ray tube Focal spot nominal size, with respect to reference axis ( Fig. A-8, p. A-26) Focal spot horizontal tolerance, with respect to reference axis ( Fig. A-8, p. A-26) Anode angle, with respect to reference axis ( Fig. A-8, p. A-26) Anode material Total filtration Maximum X-ray tube loading factors for 1h;3mA (at 110 kv) Tube 1320 W at 100 kv / 13.2 ma / 0.1 s Single-focus stationary-anode tube 0.6 acc. to IEC +/- 0.5 mm 9 Tungsten 3 mm Al, including 0.05 mm Cu mas/h 2000 W at 100 kv / 20 ma / 0.1 s EIA 343, 60 Hz refresh rate, like NTSC, no color Scintillator: Cesium iodide Nominal sizes: 31 / 23 / (17) cm or 23 / 17 / (10) cm Anti-scatter grid Pb 8/40 Pb 8/40 Table A-10 Technical data of the (Japan) (cont.) A-52

307 Appendix Monitors Environmental conditions Dimensions Weight 18.1" flat-screen monitors Screen size: Resolution: CRT monitors Screen size: Bandwidth: Resolution: During storage During operation C-arm C-arm stand Monitor cart 460 mm (18.1") 460 mm (18.1") / 60 Hz / 50 Hz 440 mm (17") 440 mm (17") 100 MHz 100 MHz 1068 lines / 90 Hz 1125 lines / 75 Hz Temperature: 10 C to +60 C Relative air humidity: 95% max. Temperature: +15 C to +35 C Relative air humidity: 75% max. Source/image receptor distance: 970 mm Vertical free space (generator/i.i.): 750 mm Immersion depth: 680 mm Orbital rotation: 115 / 135 a Angulation: ± 225 Swiveling (panning): ±10 Horizontal movement: 220 mm Vertical movement: 430 mm With 23 cm i.i.: approx. 280 kg With flat-screen monitors: approx. 183 kg With CRT monitors: approx. 203 kg Table A-10 Technical data of the (Japan) (cont.) a. Option, not available with 31 cm i.i. A-53

308 Appendix A-54

309 Index Numerals 180 Angle (read-only box) Point (button) Angle (read-only box) Point (button) Point (button) Point Ratio (button) A Abdomen (anatomical program) 8-7 Access. No. (button) 11-5 Accessories included in the scope of delivery 4-2 Accessories, optional 2-6 Accessories, optional (U.S.A.) 2-6 Acquiring Cine loop 12-3 Active Cooling 8-14 Alarm (radiation time) 8-13 Switching off 8-13 Alert messages 8-14 Alerts During operation A-8 During power-up A-7 List of errors and alerts A-8 Alphanumeric keypad 6-9 Ambient light sensor 9-4, 14-5, Function check Anatomical programs 8-7 Abdomen 8-7 Activating 8-7 Bones 8-7 Deactivating 8-7 Heart 8-7 Soft 8-7 Angle (read-only box) 15-9, Angle of rotation Information on the monitor 16-2 Angulation C-arm 5-8 Archive Inverting the entire archive Archive (operating mode) 10-7, Archive (tab) 6-6, 10-7, 10-15, 10-18, 10-31, 10-32, 10-33, 10-34, 10-35, 10-36, 11-9, 11-10, 11-11, 11-12, 11-15, 12-4, 13-8 Arrow Adding to an image 16-6 Auto-delete function 8-11 Automatic exposure rate control 8-2 Autostore 20-3 Activating 8-11, 20-4 Autotransfer 20-2 Activating 20-3 B Backup Patient folders Restoring from CD/DVD Restoring from USB storage device Selecting patient folders Selection using search criteria Selection using the image creation date To CD/DVD To USB storage device Backup (button) 10-31, 10-32, 10-34, Backup copy Restoring from CD/DVD Restoring from USB storage device Selecting patient folders Selection using search criteria Selection using the image creation date To CD/DVD To USB storage device Basic settings 20-8 Determining the live monitor 20-9 Discarding Entering the hospital data System date 20-8 System time 20-8 Basic Settings (button) 20-8, 20-9, DE.00 i

310 Index Bones (anatomical program) 8-7 Bones (button) 6-4 Brake C-arm stand 5-5 Monitor cart 5-4 Brightness Monitor 9-2 Restoring the initial settings 9-3, 14-5 Setting 14-4 Setting on flat-screen monitors 2-12 Button 2-Point 15-5 Button 3-Point 15-8 Button 4-Point Ratio Button 4-Point Button Access. No Button Backup 10-31, 10-32, 10-34, Button Basic Settings 20-8, 20-9, Button Bones 6-4 Button Calibration 15-3 Button CD/DVD 10-14, 10-28, Button CD/DVD (Backup) 10-35, Button Cine 6-3, 12-3 Button Clean up 12-8, Button Close Horizontal Slot Collimator 4-12 Button Close Iris Collimator 6-3, 9-13 Button Close Vertical Slot Collimator 6-4, 9-14, Button Complete 12-7, Button Continuous Pulse Fluoroscopy 6-2, 8-3, 8-5 Button Contrast/Brightness 6-5, 9-3, 9-5, 9-6, 14-4, 14-6, 14-7 Button Date 20-9 Button Delete Marked Items 10-11, 10-25, 12-12, Button Delete Unmarked Items 10-11, 10-25, 12-12, Button Delete 10-11, 10-25, 12-12, Button Delete (Measurement) 15-4 Button Department Button DICOM Print 11-10, Button DICOM Retrieve 11-12, Button DICOM Store 11-9, 11-10, Button Doctor Button Dose Meter Check A-2 Button Down Arrow 6-5 Button DSA 6-8, 13-3 Button Erase Floppy Disk Button Erase USB Button Filter 6-5, 9-7, 9-9 Button Floppy Disk 10-26, Button Full-Screen Image Button Grayscale Inversion 6-5, 9-13, Button Heart 6-4 Button High Quality 6-2, 8-9 Button Hospital Button Image Swapping 6-3, 9-15 Button Invert All Button Large Patient 6-3, 8-9 Button Laser 6-5, 18-2 Button LM Button Magnify 6-5, 9-10 Button Manual Exposure Rate Setting 6-3, 8-5 Button Mark 10-10, 10-24, 11-14, 12-11, 14-12, Button Mask off Button Mask Button Metal 6-4, 8-8 Button Monitor / Dose 20-12, A-2 Button Mosaic Button MSA 13-4, 13-7, 13-9 Button Name 11-4 Button New 10-4, 10-5, 10-17, 11-2 Button Next Measuring Point 15-4, 15-6, 15-9, 15-12, 15-13, 15-16, Button Open Horizontal Slot Collimator Button Open Iris Collimator Fully 6-3, 9-14, 9-15 Button Open Iris Collimator 9-13 Button Open Vertical Slot Collimator Fully 6-4, 9-14, 9-15 Button Open Vertical Slot Collimator 9-14, Button Patient ID 11-2, 11-5 Button PAUSE 17-3 Button Play 12-6, 13-11, 13-13, 17-3 Button Print Live Monitor Image 6-5, 8-12, 10-13, 10-26, 12-13, Button Print 10-13, 12-13, Button Protect 10-24, 12-11, Button P-Sh Button Query 11-2 Button REC 17-2 Button Refresh 11-13, Button Reposition 6-4, 8-8 Button Restore CD/DVD Button Restore USB Button Retrieve 11-12, 11-15, Button Reverse Left/Right 6-3, 9-16, Button Reverse Up/Down 6-3, 9-16, Button Rotate Image CCW 6-3, 9-17, Button Rotate Image CW 6-3, 9-17, Button Rotate Image to 0 6-3, 9-17 ii DE.00

311 Index Button Rotate Vertical Slot Collimator CCW 9-14 Button Rotate Vertical Slot Collimator CW 9-14 Button Rotate Vertical Slot Collimator to 0 6-4, 9-14 Button RSA 13-5, 13-8, Button Save 6-5, 8-11, 16-5, 16-6 Button Search (Archive operating mode) 10-15, 10-18, 12-4 Button Search (Patient operating mode) 10-5, Button Size 16-6 Button Snapshot 6-2, 8-4, 8-5 Button Soft 6-4 Button Start Img 12-7, Button Stop Img 12-7, Button Stop 12-6, 12-7, 12-8, 13-11, Button Storage Media 20-15, Button Text 6-5, 16-4, 16-5 Button Time 20-9 Button Up Arrow 6-4 Button USB 10-13, 10-27, Button USB (Backup) 10-32, Button VCR 6-5, 17-2, 17-3 Button WNDW 9-5, 14-6 Button Worklist 11-3, 11-5, 11-6, 11-7 Button Zoom 6-5, 9-11, 9-12, 14-9, Buttons ON/OFF 6-9 UP/DOWN 6-9 Buttons on the control panel 6-1, 6-2 C Cable connections 4-3 Cables Coupling cable 4-3, 7-1 Power cable 4-3, 7-1 Calibrating 15-3 Calibration (button) 15-3 C-arm Angulation 5-8 Horizontal movement 5-10 Movements 5-6 Orbital rotation 5-7 Swiveling (panning) 5-9 Vertical movement 5-11 C-arm power assist (U.S. option) 21-1 C-arm stand 2-7 Brake 5-5 Dimensions A-31 Illustration 2-7, 2-8 Steering 5-5 Transport position 5-1 CD Backup copy Restoring backed-up data Saving a cine loop Saving images Saving patient folders Saving single cine loop images Storage format 10-14, 10-27, 12-14, CD/DVD (button in Backup) 10-35, CD/DVD (button) 10-14, 10-28, Checks Checking the useful beam A-4 Consistency test A-2 Regular checks A-1 Routine checks by the user A-1 Cine (button) 6-3, 12-3 Cine loop 12-1 Acquiring 12-3 Applications 12-1 Auto setting 12-1 Changing the playback speed 12-6, Cleaning up 12-8, Controlling 12-6, Defining a mask image Deleting Deleting single images Frame rate 12-1 Length 12-1 Marking Marking single images Mosaic view Opening 12-4 Presetting the length 20-6 Presetting the recording speed 20-6 Printing on video printer Printing single images Processing 12-6, 12-8, Processing single images Protecting Protecting single images Replaying 12-4, 12-6, 12-10, Saving single images to a USB storage device Saving single images to floppy disk Saving to hard disk 12-2 Start image 12-7, Stop image 12-7, DE.00 iii

312 Index Trimming 12-7, Unmarking Unprotecting Writing single images to CD/DVD Writing to CD/DVD Clean up (button) 12-8, Cleaning A-6 Monitor A-6 Recommended detergents A-6 Close Horizontal Slot Collimator (button) Close Iris Collimator (button) 6-3, 9-13 Close Vertical Slot Collimator (button) 6-4, 9-14, Collimators Iris collimator 9-13 Slot collimator 9-14 Virtual collimator 9-15 Complete (button) 12-7, Config (tab) 6-6, 20-2, 20-3, 20-4, 20-5, 20-6, 20-7, 20-9, 20-10, 20-15, 20-16, A-2 Configuration 4-4 Ambient light sensor Autostore 20-3 Autotransfer 20-2 Basic settings 20-8 CD/DVD storage format Checking the ambient light sensor Crosshair 20-4 Deleting all images from a floppy disk Deleting all images from a USB storage device Determining the live monitor 20-9 Discarding the operation settings 20-7 Entering the hospital data Floppy disk storage format Monitor / Dose Operation settings 20-2 Service settings 20-1 Storage media System date 20-8 System time 20-8 USB device storage format Configuration (operating mode) 20-1 Consistency test A-2 Continuous pulse fluoroscopy 8-2 Continuous Pulse Fluoroscopy (button) 6-2, 8-3, 8-5 Contrast Monitor 9-2 Restoring the initial settings 9-3, 14-5 Setting 14-4 Setting on flat-screen monitors 2-12 Contrast/Brightness (button) 6-5, 9-3, 9-5, 9-6, 14-4, 14-6, 14-7 Control panel 6-1 Elements 6-1 Cooling curve A-28 Cooling System, Active 8-14 Coupling cable 4-3, 7-1 Crosshair 20-4 Showing 20-4 Current (display) 6-7, 8-9 D Date (button) 20-9 Date format 20-8 Date of saving Information on the monitor 16-2 Delete (button in Measurement mode) 15-4 Delete (button) 10-11, 10-25, 12-12, Delete Marked Items (button) 10-11, 10-25, 12-12, Delete protection Removing from a cine loop Removing from an image Delete Unmarked Items (button) 10-11, 10-25, 12-12, Deleting All images from a floppy disk All images from a USB storage device Cine loop Image 10-25, Patient folders Single cine loop images Department (button) Department (input box) DICOM Downloading a Worklist 11-2 Downloading patient data 11-1 Images (list) Networkability 2-3 Series (list) Studies (list) DICOM network printer Printing images 11-9 DICOM Print (button) 11-10, DICOM Retrieve (button) 11-12, DICOM server Downloading a Worklist 11-2 iv DE.00

313 Index Downloading patient data 11-1 Importing images Saving patient folders 11-8 DICOM Store 11-8 DICOM Store (button) 11-9, 11-10, Digital collimation Digital radiography 8-4 Digital zoom 9-11 Zoom factor 9-11, 9-12, 14-9, Digital zoom (post-processing) 14-9 Dimensions C-arm stand A-31 Monitor cart with CRT monitors A-34 Monitor cart with flat-screen monitors A-34 Direct radiography 19-1 Collimator apertures 19-2 Film cassette holder 19-1 Making 19-2 Tube current 19-2 Disinfection A-6 Displays Current 6-7, 8-9 Dose Area Product 6-7 mas 19-3 Pulses /s 6-7 Pulsewidth % 6-7 Radiation Time 6-7, 8-13 Tube current time 19-3 Voltage 6-6, 8-9, 19-3 Displays on the control panel 6-1 Doctor (button) Doctor (input box) Dose Area Product (display) 6-7 Dose measurement chamber Technical data A-39 Voltage correction A-40 Dose Meter Check (button) A-2 Down Arrow (button) 6-5 DSA 13-1 DSA (button) 6-8, 13-3 DSA cine loop 13-1 Acquiring 13-2 DVD Backup copy Restoring backed-up data Saving a cine loop Saving images Saving patient folders Saving single cine loop images Storage format 10-14, 10-27, 12-14, E Edge filter 9-8 Information on the monitor 16-2 Levels 9-8, 14-8 Edge filter (post-processing) 14-8 Edges Enhancement 9-8 Electronic image magnification 9-10 Emergencies Switching off 7-3 EMERGENCY STOP button 2-4, 7-3 Enhancement Edges 9-8 Entire archive Grayscale inversion Erase Floppy Disk (button) Erase USB (button) Error During operation A-8 During power-up A-7 List of errors and alerts A-8 Error messages 8-14 Exposure rate control, automatic 8-2 Exposure rate setting, manual 8-5 F Film cassette holder 19-1 Fitting 19-1 Filter (button) 6-5, 9-7, 9-9 Filters Edge filter 9-8 Edge filter (post-processing) 14-8 In the live image 9-7 Noise suppression 9-7, 9-9 Recursive filter 9-7 Stack filter 9-9 First power-up of the system 4-3 Flat-screen monitors Dimensions of monitor cart A-34 Monitor settings 2-12 Floppy disk Deleting all images Saving images 10-26, Saving single cine loop images Storage format 10-26, 14-15, Floppy Disk (button) 10-26, Fluoro (tab) 6-6 Fluoroscopy (operating mode) 6-2, DE.00 v

314 Index Defining as start screen 20-5 Fluoroscopy modes 8-2 Continuous pulse fluoroscopy 8-2 Digital radiography (snapshot) 8-4 Fluoroscopy parameters Information on the monitor 16-3 Fluoroscopy programs 8-7 Focal spot position A-26 Foot switch 6-10 Foreign body localization 18-2 Four-Point (button) Four-Point Ratio (button) Frame rate Cine loop 12-1 Full-screen image Displaying an image at full-screen size Full-Screen Image (button) Functions High quality 8-8 Large patient 8-9 Metal artifact correction 8-8 Reposition 8-8 Functions, optional 2-4 G Gettering the image intensifier tube A-5 Graphics format CD/DVD 10-14, 10-27, 12-14, Floppy disk 10-26, 14-15, USB storage device 10-13, 10-27, 12-13, Grayscale inversion All images Entire archive Image 9-13 Undoing the grayscale inversion Grayscale Inversion (button) 6-5, 9-13, Grayscale inversion (post-processing) Image H Hand switch 6-10 Hard disk Saving a cine loop 12-2 Saving images 8-10 Heart (anatomical program) 8-7 Heart (button) 6-4 Heat capacity A-28 Heating curve A-28 High Quality (button) 6-2, 8-9 High quality (function) 8-8 Horizontal image reversal 9-16 Horizontal image reversal (post-processing) Horizontal movement C-arm 5-10 Hospital (button) Hospital (input box) Hospital data Entering Information on the monitor 16-1 I Illustrations C-arm stand 2-7, 2-8 Dimensions of C-arm stand A-31, A-32 Dimensions of monitor cart A-34 Monitor cart with CRT monitors 2-10, 2-11 Monitor cart with flat-screen monitors 2-9 Transport position of the C-arm stand 5-2 Transport position of the monitor cart 5-3 Image Adding a marker 16-6 Adding an arrow 16-6 Adding text 16-5 Comparing 9-15 Deleting 10-25, Displaying at full-screen size Documenting 17-1 Edge enhancement 9-8 Grayscale inversion 9-13 Grayscale inversion (post-processing) Importing from DICOM server Inverting all images Left/right 9-16 Marking 10-23, Mirroring (reversal) 9-16 Mirroring (reversal) (post-processing) Note 16-5 Print live monitor image on video printer 8-12 Printing on DICOM network printer 11-9 vi DE.00

315 Index Printing on video printer 10-26, 14-16, 17-1 Processing Protecting 10-24, 12-11, Recording on video cassette recorder 17-2 Replaying on video cassette recorder 17-3 Rotating 9-17 Rotating (post-processing) Rotating to Saving to floppy disk 10-26, Saving to hard disk 8-10 Saving to USB storage device 10-27, Undoing the grayscale inversion 9-13 Undoing the grayscale inversion of all images Unmarking 10-24, Unprotecting 10-24, Up/down 9-16 Writing to CD/DVD Image crop Image data Managing 10-7 Image detail Enlarging 9-11 Image documentation 17-1 Image information 16-1 Image magnification level 6-5 Image number 8-10 Information on the monitor 16-1 Image reversal Horizontal image reversal 9-16 Vertical image reversal 9-16 Image rotation 9-17 Image rotation (post-processing) Image swapping 9-15 Image Swapping (button) 6-3, 9-15 Images (DICOM list) Importing Images from DICOM server Input box Department Input box Doctor Input box Hospital Input box Reference Length 15-4 Input box Time 20-9 Invert All (button) Iris collimator 9-13 Closing 9-13 Opening 9-13 Opening fully 9-14, 9-15 J Japan Technical data A-51 K Key switch 2-4, 7-4 Power on 7-4 X-Ray on/off 7-4 Keypad, alphanumeric 6-9 L Labels C-arm stand A-16 Generator A-17 Image intensifier A-17 Monitor cart A-18 Landmarking Large Patient (button) 6-3, 8-9 Large patient (function) 8-9 Laser Laser Class 3-5, 18-1 Laser positioning device 3-5 Maintenance 3-5 Laser (button) 6-5, 18-2 Laser positioning device 18-1 Applications 18-1 Localizing foreign bodies 18-2 Technical data A-39 Last Image Hold 8-9 Leakage in the cooling system A-5 Left/right 9-2, 9-16 Information on the monitor 16-2 Length Cine loop 12-1 Length 1 (read-only box) 15-6, 15-9, 15-12, Length 1 / Length 2 (read-only box) Length 2 (read-only box) 15-9, 15-12, Length or distance Measuring 15-5 Live Image left (option button) Live Image right (option button) Live monitor 2-11 Defining 20-9 LM (button) DE.00 vii

316 Index Locking Entire system 7-4 X-rays 7-4 M Magnification, electronic 9-10 Magnify (button) 6-5, 9-10 Manual exposure rate setting 8-5 Activating 8-5 Deactivating 8-6 Manual Exposure Rate Setting (button) 6-3, 8-5 Mark (button) 10-10, 10-24, 11-14, 12-11, 14-12, Marker Adding to an image 16-6 Deleting 16-7 Editing 16-6 Marking Cine loop Image 10-23, Patient folders Single cine loop images mas (display) 19-3 Mask (button) Mask image 13-2 Mask off (button) Measure (tab) 6-6, 15-3, 15-5, Measurement 2-point measurement point measurement point measurement point ratio measurement Button Delete 15-4 Calibrating 15-3 Length or distance 15-5 Length ratio Reference length 15-6, 15-9, Reference object 15-3 Measurement (operating mode) 15-1 Measuring functions 15-1 Metal (button) 6-4, 8-8 Metal artifact correction 8-8 Activating 8-8 Deactivating 8-8 Metal artifact correction (function) 8-8 Monitor / Dose Monitor / Dose (button) 20-12, A-2 Monitor assignment 2-11 Monitor cart 2-9 Brake 5-4 Dimensions A-34 Dimensions with flat-screen monitors A-34 Steering 5-4 Transport position 5-2 Monitor cart, illustration 2-9, 2-10, 2-11 Monitor settings 18.1" flat-screen monitors 2-12 Brightness 9-2, 14-4 Contrast 9-2, 14-4 Mosaic (button) Mosaic view 10-8 Movement C-arm 5-6 MSA 13-1 MSA (button) 13-4, 13-7, 13-9 MSA image Acquiring 13-4 N Name (button) 11-4 Native image 13-2 Hiding 20-7 Showing 20-7 Networkability 2-3 New (button) 10-4, 10-5, 10-17, 11-2 Next Measuring Point (button) 15-4, 15-6, 15-9, 15-12, 15-13, 15-16, Noise suppression Recursive filter 9-7 Stack filter 9-9 Note on the image 16-5 O OFF switches 6-9, 7-2 ON/OFF switches 6-9, 7-2 Open Horizontal Slot Collimator (button) Open Iris Collimator (button) 9-13 Open Iris Collimator Fully (button) 6-3, 9-14, 9-15 Open Vertical Slot Collimator (button) 9-14, Open Vertical Slot Collimator Fully (button) 6-4, 9-14, 9-15 viii DE.00

317 Index Operating modes Archive 10-7, Configuration 20-1 Fluoroscopy 8-1 Measurement 15-1 Patient 10-2, Post Process 14-1, 14-12, Radiography 19-2, 19-3 Subtraction 8-1 Text 16-4 Operation settings 20-2 Autostore 20-3 Autotransfer 20-2 CD/DVD storage format Crosshair 20-4 Defining the start screen 20-5 Discarding 20-7 Floppy disk storage format USB device storage format Option button Live Image left Option button Live Image right Optional accessories 2-6 Optional accessories (U.S.A.) 2-6 Optional functions 2-4 Orbital rotation C-arm 5-7 P Patient (operating mode) 10-2, Activating 10-3 Defining as start screen 20-5 Patient (tab) 6-6, 10-3, 10-4, 10-5, 10-17, 11-1, 11-3, 11-4, 11-6 Patient data Downloading from DICOM server 11-1 Editing 10-5 Entering manually 10-4 Information on the monitor 16-1 Managing 10-2 Patient folders 10-1 Activating Backup Backup to CD/DVD Backup to USB storage device Creating a new patient folder 10-3 Deleting Displaying image information Editing data 10-5 Marking Printing on video printer Processing 10-8 Saving to USB storage device Search criteria Searching 10-5, Storage capacity 10-1 Subject 10-2 Unmarking Writing to CD/DVD Patient ID Display 10-2 Length 10-2 Patient ID (button) 11-2, 11-5 PAUSE (button) 17-3 Pixel shift Play (button) 12-6, 13-11, 13-13, 17-3 Post Proc. (tab) 6-6, 14-3 Post Process 14-1 Activating an image 14-3 Digital zoom 14-9 Edge filter 14-8 Image reversal Image rotation Inverting the image grayscale Printing images on video printer Protecting an image Saving images to floppy disk Post Process (operating mode) 14-12, Power cable 4-3, 7-1 Print (button) 10-13, 12-13, Print Live Monitor Image (button) 6-5, 8-12, 10-13, 10-26, 12-13, Printing Cine loops on video printer Images on DICOM network printer 11-9 Images on video printer 10-26, 14-16, 17-1 Live monitor image on video printer 8-12 Measured values 8-12 Patient folders on video printer Single cine loop images on video printer Text information 8-12 Protect (button) 10-24, 12-11, Protecting Cine loop Image 10-24, 12-11, Image (post-processing) Protective grounding 3-4 P-Sh (button) Pulses /s (display) 6-7 Pulsewidth % (display) DE.00 ix

318 Index Q RSA image Acquiring 13-5 Query (button) 11-2 R Radiation controlled area 3-3 Radiation time Alarm 8-13 Warning function 8-13 Radiation Time (display) 6-7, 8-13 Radiography (operating mode) 19-2, 19-3 Radiography (tab) 6-6, 19-2 Read-only box 180 Angle Read-only box 360 Angle 15-9 Read-only box Angle 15-9, Read-only box Length 1 / Length Read-only box Length , 15-9, 15-12, Read-only box Length , 15-12, Read-only box Reference Length 15-6, 15-9, 15-12, REC (button) 17-2 Recursive filter 9-7 Information on the monitor 16-2 Levels 9-7 Noise suppression 9-7 Reference Length (input box) 15-4 Reference Length (read-only box) 15-6, 15-9, 15-12, Reference monitor 2-11 Refresh (button) 11-13, Reposition (button) 6-4, 8-8 Reposition (function) 8-8 Restore CD/DVD (button) Restore USB (button) Retrieve (button) 11-12, 11-15, Reverse Left/Right (button) 6-3, 9-16, Reverse Up/Down (button) 6-3, 9-16, Rotate Image CCW (button) 6-3, 9-17, Rotate Image CW (button) 6-3, 9-17, Rotate Image to 0 (button) 6-3, 9-17 Rotate Vertical Slot Collimator CCW (button) 9-14 Rotate Vertical Slot Collimator CW (button) 9-14 Rotate Vertical Slot Collimator to 0 (button) 6-4, 9-14 RSA 13-1 RSA (button) 13-5, 13-8, S Safety instructions Electromagnetic compatibility 3-3 Environmental compatibility 3-6 Equipotential grounding 3-4 General safety instructions 3-1 Laser radiation 3-5 Protective grounding 3-4 X-rays 3-2 Save (button) 6-5, 8-11, 16-5, 16-6 Saving Cine loops to CD/DVD Cine loops to hard disk 12-2 Images to CD/DVD Images to floppy disk 10-26, Images to hard disk 8-10 Images to USB storage device 10-27, Patient folders to CD/DVD Patient folders to DICOM server 11-8 Patient folders to USB storage device Single cine loop images to a USB storage device Single cine loop images to CD/DVD Single cine loop images to floppy disk Scattered radiation A-29 Search (button in Archive operating mode) 10-15, 10-18, 12-4 Search (button in Patient operating mode) 10-5, Search criteria for patient folders Security key switch 7-4 Series (DICOM list) Service settings 20-1 Size (button) 16-6 Slot collimator 9-14 Closing 9-14 Opening 9-14 Opening fully 9-14 Rotating 9-14 Rotating to Snapshot 8-4 Snapshot (button) 6-2, 8-4, 8-5 Soft (anatomical program) 8-7 x DE.00

319 Index Soft (button) 6-4 Stack filter 9-9 Information on the monitor 16-2 Noise suppression 9-9 Number of images 9-9 Standard fluoroscopy 8-1 Standard windowing 9-4 Standard windowing (post-processing) 14-6 Start image of a cine loop 12-7, Start Img (button) 12-7, Start screen Defining 20-5 Steering C-arm stand 5-5 Monitor cart 5-4 Step windowing 9-4 Step windowing (post-processing) 14-6 Sterilization A-7 Stop (button) 12-6, 12-7, 12-8, 13-11, Stop image of a cine loop 12-7, Stop Img (button) 12-7, Storage format CD/DVD 10-14, 10-27, 12-14, Floppy disk 10-26, 14-15, USB storage device 10-13, 10-27, 12-13, Storage media Storage Media (button) 20-15, Studies (DICOM list) Subject 10-2 Subtracted image 13-2 Subtraction (operating mode) 6-8, 8-1 Defining as start screen 20-5 Subtraction (tab) 6-6, 13-2 Subtraction modes Acquiring a DSA cine loop 13-2 Acquiring an MSA image 13-4 Acquiring an RSA image 13-5 DSA 13-1 Landmarking Mask image 13-2 MSA 13-1 Native image 13-2 Pixel shift RSA 13-1 Subtracted image 13-2 Switches Hand switch 6-10 Two-pedal foot switch 6-10 Switching off in emergency situations 7-3 Switching on First power-up of the system 4-3 Swiveling (panning) C-arm 5-9 System ON/OFF switches 7-2 Preparing 7-1 Switching on 7-2 System date 20-8 System time 20-8 T Tab Archive 6-6, 10-7, 10-15, 10-18, 10-31, 10-32, 10-33, 10-34, 10-35, 10-36, 11-9, 11-10, 11-11, 11-12, 11-15, 12-4, 13-8 Tab Config 6-6, 20-2, 20-3, 20-4, 20-5, 20-6, 20-7, 20-9, 20-10, 20-15, 20-16, A-2 Tab Fluoro 6-6 Tab Measure 6-6, 15-3, 15-5, Tab Patient 6-6, 10-3, 10-4, 10-5, 10-17, 11-1, 11-3, 11-4, 11-6 Tab Post Proc. 6-6, 14-3 Tab Radiography 6-6, 19-2 Tab Subtraction 6-6, 13-2 Technical data A-35 Temperature in the generator 8-14 Temperature monitoring 8-14 Temperature symbol 6-7, 8-14 Text Adding to an image 16-5 Deleting 16-6 Editing 16-6 Text (button) 6-5, 16-4, 16-5 Text (operating mode) 16-4 Three-point (button) 15-8 Time (button) 20-9 Time (input box) 20-9 Time of saving Information on the monitor 16-2 Touchpad (digital zoom) 9-12 Transport position C-arm stand 5-1 Monitor cart 5-2 Two-pedal foot switch 6-10 Assignment 6-10 Two-Point (button) DE.00 xi

320 Index U U.S.A. C-arm power assist (option) 21-1 Labels on the C-arm stand A-40 Labels on the generator A-41 Labels on the image intensifier A-41 Labels on the monitor cart A-42 Optional accessories 2-6 Unpacking the system 4-1 Up Arrow (button) 6-4 Up/down 9-2, 9-16 Information on the monitor 16-2 UP/DOWN buttons 6-9 USB (button in Backup) 10-32, USB (button) 10-13, 10-27, USB storage device Backup copy Deleting all images Restoring backed-up data Saving images 10-27, Saving patient folders Saving single cine loop images Storage format 10-13, 10-27, 12-13, V VCR (button) 6-5, 17-2, 17-3 Vertical image reversal 9-16 Vertical image reversal (post-processing) Vertical movement C-arm 5-11 Vertical slot collimator Opening fully 9-14, 9-15 Rotating to Video BNC socket 2-16 VIDEO OUT 2-16 Video output 2-16 Video signal 2-16 Video cassette recorder Documenting an image 17-1 Recording images 17-2 Replaying images 17-3 Video printer Documenting an image 17-1 Printing a cine loop Printing images 10-26, 14-16, 17-1 Printing patient folders Printing the live monitor image 8-12 Virtual collimator 9-15 Vision Center (control panel) 6-1 Voltage (display) 6-6, 8-9, 19-3 W Warning function (radiation time) 8-13 Warning symbols Temperature 6-7, 8-14 X-rays 6-7, 8-10, 8-13 Windowing 9-4, 14-5 Restoring the factory settings 9-5, 9-6, 14-7 Standard windowing 9-4 Step windowing 9-4 Windowing values Information on the monitor 16-2 WNDW (button) 9-5, 14-6 Worklist Downloading from DICOM server 11-2 Worklist (button) 11-3, 11-5, 11-6, 11-7 Writing Backup to CD/DVD Cine loops to CD/DVD Images to CD/DVD Patient folders to CD/DVD Single cine loop images to CD/DVD X X-ray symbol 6-7, 8-10, 8-13 Z Zoom 9-11 Zoom factor 9-11, 9-12, 14-9, Zoom (button) 6-5, 9-11, 9-12, 14-9, Zoom (post-processing) 14-9 Zoom factor Digital zoom 9-11, 9-12, 14-9, xii DE.00

321 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class A) Guidance and Manufacturer s Declaration electromagnetic emissions The is intended for use in the electromagnetic environment specified below. The customer or the user of the should assure that it is used in such an environment. Emissions tests Compliance Electromagnetic environment guidance RF emissions according to CISPR 11 RF emissions according to CISPR 11 Harmonic emissions according to IEC Voltage fluctuations/ flicker emissions according to IEC Group 1 Class A Not applicable Not applicable The uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment. The is suitable for use in all establishments other than domestic and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes. Table 1 Guidance and Manufacturer s Declaration electromagnetic emissions Rev. 10/2004 1

322 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class A) Guidance and Manufacturer s Declaration electromagnetic immunity The is intended for use in the electromagnetic environment specified below. The customer or the user of the should assure that it is used in such an environment. Immunity tests IEC test level Electrostatic discharge (ESD) according to IEC Electrical fast transient/burst according to IEC Surge according to IEC Voltage dips, short interruptions, and voltage variations on power supply input lines according to IEC Power frequency (50/60 Hz) magnetic field according to IEC kv contact discharge + 8 kv air discharge + 2 kv for power supply lines + 1 kv for input/ output lines + 1 kv differential mode + 2 kv common mode < 5% U T for 0.5 cycle (> 95% dip) 40% U T for 5 cycles (60% dip) 70% U T for 25 cycles (30% dip) < 5% U T for 5 s (> 95% dip) Compliance level + 6 kv contact discharge + 8 kv air discharge + 2 kv for power supply lines + 1 kv for input/ output lines + 1 kv differential mode + 2 kv common mode < 5% U T for 0.5 cycle (> 95% dip) 40% U T for 5 cycles (60% dip) 70% U T for 25 cycles (30% dip) < 5% U T for 5 s (> 95% dip) Electromagnetic environment guidance Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%. Mains power quality should be that of a typical commercial or hospital environment. Mains power quality should be that of a typical commercial or hospital environment. Mains power quality should be that of a typical commercial or hospital environment. If the user of the requires continued operation during power mains interruptions, it is recommended that the be powered from an uninterruptible power supply or battery. 3 A/m 3 A/m Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment. NOTE: U T is the AC mains voltage prior to application of the test level Table 2 Guidance and Manufacturer s Declaration electromagnetic immunity Rev. 10/2004

323 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class A) Guidance and Manufacturer s Declaration electromagnetic immunity The is intended for use in the electromagnetic environment specified below. The customer or the user of the should assure that it is used in such an environment. Immunity tests IEC test level Conducted RF according to IEC Radiated RF according to IEC V rms 150 khz to 80 MHz 3 V/m 80 MHz to 2.5 GHz Compliance level Electromagnetic environment guidance Portable and mobile RF communications equipment should be used no closer to the, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended separation distance: 3 V rms d = 1.2 SQRT(P) 3 V/m d = 1.2 SQRT(P) 80 MHz to 800 MHz d = 2.3 SQRT(P) 800 MHz to 2.5 GHz where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters (m). Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey a, should be less than the compliance level b in each frequency range. Interference may occur in the vicinity of equipment marked with the following symbol: Table 3 Guidance and Manufacturer s Declaration electromagnetic immunity Rev. 10/2004 3

324 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class A) Immunity tests IEC test level Compliance level Electromagnetic environment guidance NOTE 1: At 80 MHz and 800 MHz, the higher frequency range applies. NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. a Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the is used exceeds the applicable RF compliance level above, the should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating the. b Over the frequency range 150 khz to 80 MHz, field strengths should be less than 3 V/m. Table 3 Guidance and Manufacturer s Declaration electromagnetic immunity Rev. 10/2004

325 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class A) Recommended separation distances between portable and mobile RF communications equipment and the The is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the as recommended below, according to the maximum output power of the communications equipment. Rated maximum output power of transmitter W Separation distance according to frequency of transmitter m 150 khz to 80 MHz d = 1.2 SQRT(P) 80 MHz to 800 MHz d = 1.2 SQRT(P) 800 MHz to 2.5 GHz d = 2.3 SQRT(P) For transmitters rated at a maximum output power not listed in the above table, the distance can be determined using the equation in the respective column header, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. NOTE 1: An additional factor of 10/3 is used in calculating the recommended separation distance for transmitters in the frequency range 80 MHz to 2.5 GHz to decrease the likelihood that mobile/portable communications equipment could cause interference if it is inadvertently brought into patient areas. NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. Table 4 Recommended separation distances between portable and mobile RF communications equipment and the Rev. 10/2004 5

326 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class A) Rev. 10/2004

327 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class B) Guidance and Manufacturer s Declaration electromagnetic emissions The is intended for use in the electromagnetic environment specified below. The customer or the user of the should assure that it is used in such an environment. Emissions tests Compliance Electromagnetic environment guidance RF emissions according to CISPR 11 RF emissions according to CISPR 11 Harmonic emissions according to IEC Voltage fluctuations/ flicker emissions according to IEC Group 1 Class B Class A Complies The uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment. The is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes. Table 1 Guidance and Manufacturer s Declaration electromagnetic emissions Rev. 10/2004 1

328 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class B) Guidance and Manufacturer s Declaration electromagnetic immunity The is intended for use in the electromagnetic environment specified below. The customer or the user of the should assure that it is used in such an environment. Immunity tests IEC test level Electrostatic discharge (ESD) according to IEC Electrical fast transient/burst according to IEC Surge according to IEC Voltage dips, short interruptions, and voltage variations on power supply input lines according to IEC Power frequency (50/60 Hz) magnetic field according to IEC kv contact discharge + 8 kv air discharge + 2 kv for power supply lines + 1 kv for input/ output lines + 1 kv differential mode + 2 kv common mode < 5% U T for 0.5 cycle (> 95% dip) 40% U T for 5 cycles (60% dip) 70% U T for 25 cycles (30% dip) < 5% U T for 5 s (> 95% dip) Compliance level + 6 kv contact discharge + 8 kv air discharge + 2 kv for power supply lines + 1 kv for input/ output lines + 1 kv differential mode + 2 kv common mode < 5% U T for 0.5 cycle (> 95% dip) 40% U T for 5 cycles (60% dip) 70% U T for 25 cycles (30% dip) < 5% U T for 5 s (> 95% dip) Electromagnetic environment guidance Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%. Mains power quality should be that of a typical commercial or hospital environment. Mains power quality should be that of a typical commercial or hospital environment. Mains power quality should be that of a typical commercial or hospital environment. If the user of the requires continued operation during power mains interruptions, it is recommended that the be powered from an uninterruptible power supply or battery. 3 A/m 3 A/m Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment. NOTE: U T is the AC mains voltage prior to application of the test level Table 2 Guidance and Manufacturer s Declaration electromagnetic immunity Rev. 10/2004

329 Manufacturer s Declaration regarding Electromagnetic Compatibility according to IEC (Class B) Guidance and Manufacturer s Declaration electromagnetic immunity The is intended for use in the electromagnetic environment specified below. The customer or the user of the should assure that it is used in such an environment. Immunity tests IEC test level Conducted RF according to IEC Radiated RF according to IEC V rms 150 khz to 80 MHz 3 V/m 80 MHz to 2.5 GHz Compliance level Electromagnetic environment guidance Portable and mobile RF communications equipment should be used no closer to the, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended separation distance: 3 V rms d = 1.2 SQRT(P) 3 V/m d = 1.2 SQRT(P) 80 MHz to 800 MHz d = 2.3 SQRT(P) 800 MHz to 2.5 GHz where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters (m). Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey a, should be less than the compliance level b in each frequency range. Interference may occur in the vicinity of equipment marked with the following symbol: Table 3 Guidance and Manufacturer s Declaration electromagnetic immunity Rev. 10/2004 3